Intervention to reduce the incidence of methicillin-resistant Staphylococcus aureus skin infections in a correctional facility in Georgia.
OBJECTIVE
In August 2001, a cluster of MRSA skin infections was detected in a correctional facility. An investigation was conducted to determine its cause and to prevent further MRSA infections.


METHODS
Case-control study.


METHODS
A 200-bed detention center.


METHODS
A case was defined as a detainee with a skin lesion from which MRSA was cultured from July 24 through December 31, 2001. Case-patients were identified by review of laboratory culture results and by skin lesion screening through point-prevalence survey and admission examination. Controls were randomly selected from an alphabetized list of detainees.


METHODS
Medical staff implemented measures to improve skin disease screening, personal hygiene, wound care, and antimicrobial therapy.


RESULTS
Sixteen cases were identified: 11, 5, and 0 in the preintervention, peri-intervention, and postintervention periods, respectively. Seven case-patients and 19 controls were included in the case-control study. On multivariable analysis, working as a dormitory orderly (OR, 9.8; CI95, 0.74-638; P = .10) and a stay of longer than 36 days (OR, 6.9; CI95, 0.65-128.2; P = .14) were the strongest predictors for MRSA skin infection. The preintervention, peri-intervention, and postintervention MRSA infection rates were 11.6, 8.8, and 0 per 10,000 detainee-days, respectively. The rate of MRSA skin infections declined significantly between both the preintervention and peri-intervention periods and the postintervention period (P < .01 for both comparisons).


CONCLUSIONS
MRSA skin disease can become an emergent problem in a correctional facility. Interventions targeted at skin disease screening, appropriate antimicrobial treatment, and hygiene may decrease the risk of acquiring MRSA infection in correctional facilities.
Wootton
Susan H
SH
Centers for Disease Control and Prevention, Epidemiology Program Office, Division of Applied Public Health Training, Epidemic Intelligence Service Branch, Atlanta, Georgia, USA.
Arnold
Kathryn
K
Hill
Holly A
HA
McAllister
Sigrid
S
Ray
Marsha
M
Kellum
Molly
M
LaMarre
Madie
M
Lane
Mary Ellen
ME
Chaitram
Jasmine
J
Lance-Parker
Susan
S
Kuehnert
Matthew J
MJ
D016022:Case-Control Studies; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016106:Methicillin Resistance; D011329:Prisoners; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification*