title: Impact of Detection, Education, Research and Decolonization without Isolation in Long-term care (DERAIL) on methicillin-resistant Staphylococcus aureus colonization and transmission at 3 long-term care facilities.
abstract: We tested infection prevention strategies to limit exposure of long-term care facility residents to drug-resistant pathogens in a prospective, cluster randomized 2-year trial involving 3 long-term care facilities (LTCFs) using methicillin-resistant Staphylococcus aureus (MRSA) as a model. We hypothesized that nasal MRSA surveillance using rapid quantitative polymerase chain reaction and decolonization of carriers would successfully lower overall MRSA colonization. In year 1, randomly assigned intervention units received decolonization with nasal mupirocin and chlorhexidine bathing and enhanced environmental cleaning with bleach every 4 months. Newly admitted MRSA nares-positive residents were decolonized on admission. Control units were screened but not decolonized. All units received periodic bleach environmental cleaning and instruction on hand hygiene. In year 2, all units followed intervention protocol caused by failure of the cluster randomized approach to sufficiently segregate patients. MRSA colonization was monitored using point prevalence testing every 4-6 months. Colonization status at admission and discharge was performed 1 quarter per year to determine acquisition. Fisher exact test was used for statistical analysis. Baseline MRSA colonization rate was 16.64%. In year 1, the colonization rate of intervention units was 11.61% (P = .028) and 17.85% in control units (P = .613) compared with baseline. Intervention unit rate difference compared with the controls was significant (P = .001). In year 2, the colonization rate was 10.55% (P < .001) compared with baseline. The transmission rates were 1.66% and 3.52% in years 1 and 2, respectively (P = .034). The planned interventions of screening and decolonization were successful at lowering MRSA colonization.
authors.affiliation: Department of Infectious Disease Research, NorthShore University HealthSystem, Evanston, IL. Electronic address: dschora@northshore.org.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Schora
authors.affiliation: Department of Infectious Disease Research, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Susan
authors.initials: S
authors.lastname: Boehm
authors.affiliation: Department of Infectious Disease Research, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Sanchita
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Infectious Disease Research, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Parul A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: Department of Infectious Disease Research, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Jennifer
authors.initials: J
authors.lastname: O'Brien
authors.affiliation: Whitehall of Deerfield, Deerfield, IL; Glenview Terrace, Glenview, IL.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hines
authors.affiliation: Lutheran Life Communities, Arlington Heights, IL.
authors.forename: Deborah
authors.initials: D
authors.lastname: Burdsall
authors.affiliation: Department of Medical Social Sciences, Northwestern University, Evanston, IL.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Beaumont
authors.affiliation: Department of Infectious Disease Research, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Kari
authors.initials: K
authors.lastname: Peterson
authors.affiliation: Department of Infectious Disease Research, NorthShore University HealthSystem, Evanston, IL.
authors.forename: Maureen
authors.initials: M
authors.lastname: Fausone
authors.affiliation: Department of Infectious Disease Research, NorthShore University HealthSystem, Evanston, IL; University of Chicago, Chicago, IL.
authors.forename: Lance R
authors.initials: LR
authors.lastname: Peterson
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002353:Carrier State / Q000453:epidemiology; D002710:Chlorhexidine / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology / Q000635:transmission; D004202:Disinfectants / Q000494:pharmacology*; D017053:Infection Control / Q000379:methods*; D008134:Long-Term Care; D055624:Methicillin-Resistant Staphylococcus aureus / Q000472:pathogenicity*; D016712:Mupirocin / Q000494:pharmacology; D009666:Nose / Q000382:microbiology; D009735:Nursing Homes; D011446:Prospective Studies; D012973:Sodium Hypochlorite / Q000494:pharmacology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000635:transmission
chemical_list: D000900:Anti-Bacterial Agents; D004202:Disinfectants; D016712:Mupirocin; D012973:Sodium Hypochlorite; D002710:Chlorhexidine
keywords: Infection Prevention; Long Term Care; MRSA colonization