title: The longitudinal prevalence of MRSA in care home residents and the effectiveness of improving infection prevention knowledge and practice on colonisation using a stepped wedge study design.
abstract: Objectives To determine the prevalence and health outcomes of meticillin-resistant Staphylococcus aureus (MRSA) colonisation in elderly care home residents. To measure the effectiveness of improving infection prevention knowledge and practice on MRSA prevalence.  Setting Care homes for elderly residents in Leeds, UK.  Participants Residents able to give informed consent.  Design A controlled intervention study, using a stepped wedge design, comprising 65 homes divided into three groups. Baseline MRSA prevalence was determined by screening the nares of residents (n=2492). An intervention based upon staff education and training on hand hygiene was delivered at three different times according to group number. Scores for three assessment methods, an audit of hand hygiene facilities, staff hand hygiene observations and an educational questionnaire, were collected before and after the intervention. After each group of homes received the intervention, all participants were screened for MRSA nasal colonisation. In total, four surveys took place between November 2006 and February 2009.  Results MRSA prevalence was 20%, 19%, 22% and 21% in each survey, respectively. There was a significant improvement in scores for all three assessment methods post-intervention (p≤0.001). The intervention was associated with a small but significant increase in MRSA prevalence (p=0.023). MRSA colonisation was associated with previous and subsequent MRSA infection but was not significantly associated with subsequent hospitalisation or mortality.  Conclusions The intervention did not result in a decrease in the prevalence of MRSA colonisation in care home residents. Additional measures will be required to reduce endemic MRSA colonisation in care homes.
authors.affiliation: Leeds Teaching Hospitals NHS Trust and University of Leeds, Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds, UK.
authors.forename: C
authors.initials: C
authors.lastname: Horner
authors.forename: M
authors.initials: M
authors.lastname: Wilcox
authors.forename: B
authors.initials: B
authors.lastname: Barr
authors.forename: D
authors.initials: D
authors.lastname: Hall
authors.forename: G
authors.initials: G
authors.lastname: Hodgson
authors.forename: P
authors.initials: P
authors.lastname: Parnell
authors.forename: D
authors.initials: D
authors.lastname: Tompkins