title: An integrated approach to methicillin-resistant Staphylococcus aureus control in a rural, regional-referral healthcare setting.
abstract: OBJECTIVE
  To curtail the prevalence and cross-transmission of methicillin-resistant Staphylococcus aureus (MRSA) in a rural healthcare setting.
  
  
  METHODS
  Before-after, quasi-experimental quality improvement study.
  
  
  METHODS
  A regional-referral hospital, 5 affiliated nursing homes, and an outpatient MRSA clinic.
  
  
  METHODS
  Residents of the 5 nursing homes were screened for MRSA at baseline and 1 year later. Active surveillance cultures were performed on subsequently admitted nursing home residents, "high-risk" patients admitted to the hospital, and household contacts of clinic patients. The decolonization regimen consisted of systemic therapy with minocycline and rifampin and topical therapy with nasal mupirocin ointment and 5% tea tree oil body wash. Three separate samples for cultures to document clearance of MRSA colonization were obtained at 1-week intervals 1 month after the completion of decolonization therapy. Samples for follow-up cultures were obtained at month 6 and month 12 after the completion of decolonization therapy.
  
  
  RESULTS
  After intervention and follow-up for 12 months or more, the prevalence of MRSA carriage at the nursing homes decreased by 67% (P < .001), and 120 (82%) of 147 nursing home residents and 111 (89%) of 125 clinic patients remained culture-negative for MRSA. Twenty-three (24%) of 95 new clinic patients had at least 1 MRSA-positive contact. Mupirocin resistance did not develop. In the hospital, the incidence rate of nosocomial MRSA infection decreased from 0.64 infections per 1,000 patient-days before the interventions to 0.40 infections per 1,000 patient-days 1 year after the interventions and to 0.32 infections per 1,000 patient-days 2 years after the intervention (P < .01).
  
  
  CONCLUSIONS
  Use of active surveillance cultures and decolonization therapy was effective in decreasing the prevalence of asymptomatic carriage, the incidence of nosocomial infection, and the overall prevalence of MRSA in our rural healthcare setting.
authors.affiliation: Aspirus Wausau Hospital, Wausau, Wisconsin 54401, USA. iddoc@dwave.net
authors.forename: William A
authors.initials: WA
authors.lastname: Bowler
authors.forename: Jeanine
authors.initials: J
authors.lastname: Bresnahan
authors.forename: Ann
authors.initials: A
authors.lastname: Bradfish
authors.forename: Christine
authors.initials: C
authors.lastname: Fernandez
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D006761:Hospitals; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D019035:Rural Health Services / Q000458:organization & administration; D013203:Staphylococcal Infections / Q000517:prevention & control*; D014922:Wisconsin