title: Universal screening and decolonization for control of MRSA in nursing homes: a cluster randomized controlled study.
abstract: OBJECTIVE
  The risk of carrying methicillin-resistant Staphylococcus aureus (MRSA) is higher among nursing home (NH) residents than in the general population. However, control strategies are not clearly defined in this setting. In this study, we compared the impact of standard precautions either alone (control) or combined with screening of residents and decolonization of carriers (intervention) to control MRSA in NHs.
  
  
  METHODS
  Cluster randomized controlled trial.
  
  
  METHODS
  NHs of the state of Vaud, Switzerland.
  
  
  METHODS
  Of 157 total NHs in Vaud, 104 (67%) participated in the study.
  
  
  METHODS
  Standard precautions were enforced in all participating NHs, and residents underwent MRSA screening at baseline and 12 months thereafter. All carriers identified in intervention NHs, either at study entry or among newly admitted residents, underwent topical decolonization combined with environmental disinfection, except in cases of MRSA infection, MRSA bacteriuria, or deep skin ulcers.
  
  
  RESULTS
  NHs were randomly allocated to a control group (51 NHs, 2,412 residents) or an intervention group (53 NHs, 2,338 residents). Characteristics of NHs and residents were similar in both groups. The mean screening rates were 86% (range, 27%-100%) in control NHs and 87% (20%-100%) in intervention NHs. Prevalence of MRSA carriage averaged 8.9% in both control NHs (range, 0%-43%) and intervention NHs (range, 0%-38%) at baseline, and this rate significantly declined to 6.6% in control NHs and to 5.8% in intervention NHs after 12 months. However, the decline did not differ between groups (P=.66).
  
  
  CONCLUSIONS
  Universal screening followed by decolonization of carriers did not significantly reduce the prevalence of the MRSA carriage rate at 1 year compared with standard precautions.
authors.affiliation: 1Service of Hospital Preventive Medicine,Lausanne University Hospital,Lausanne,Switzerland.
authors.forename: Cristina
authors.initials: C
authors.lastname: Bellini
authors.affiliation: 1Service of Hospital Preventive Medicine,Lausanne University Hospital,Lausanne,Switzerland.
authors.forename: Christiane
authors.initials: C
authors.lastname: Petignat
authors.affiliation: 2Cantonal Unit for Infection Control and Prevention,Public Health Service,Lausanne,Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Masserey
authors.affiliation: 3Service of Geriatric Medicine and Geriatric Rehabilitation,Lausanne University Hospital,Lausanne,Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Büla
authors.affiliation: 4Institute of Social and Preventive Medicine,Lausanne University Hospital,Lausanne,Switzerland.
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.affiliation: 4Institute of Social and Preventive Medicine,Lausanne University Hospital,Lausanne,Switzerland.
authors.forename: Valentin
authors.initials: V
authors.lastname: Rousson
authors.affiliation: 1Service of Hospital Preventive Medicine,Lausanne University Hospital,Lausanne,Switzerland.
authors.forename: Dominique S
authors.initials: DS
authors.lastname: Blanc
authors.affiliation: 1Service of Hospital Preventive Medicine,Lausanne University Hospital,Lausanne,Switzerland.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Zanetti
mesh_terms: D000368:Aged; D003428:Cross Infection / Q000175:diagnosis / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008403:Mass Screening / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus; D009735:Nursing Homes; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000517:prevention & control*