title: Reduction of methicillin-resistant Staphylococcus aureus infection in long-term care is possible while maintaining patient socialization: A prospective randomized clinical trial.
abstract: Antibiotic resistance is a challenge in long-term care facilities (LTCFs). The objective of this study was to demonstrate that a novel, minimally invasive program not interfering with activities of daily living or socialization could lower methicillin-resistant Staphylococcus aureus (MRSA) disease.
  
  
  
  This was a prospective, cluster-randomized, nonblinded trial initiated at 3 LTCFs. During year 1, units were stratified by type of care and randomized to intervention or control. In year 2, all units were converted to intervention consisting of universal decolonization using intranasal mupirocin and a chlorhexidine bath performed twice (2 decolonization-bathing cycles 1 month apart) at the start of the intervention period. Subsequently, after initial decolonization, all admissions were screened on site using real-time polymerase chain reaction, and those MRSA positive were decolonized, but not isolated. Units received annual instruction on hand hygiene. Enhanced bleach wipe cleaning of flat surfaces was done every 4 months.
  
  
  
  There were 16,773 tests performed. The MRSA infection rate decreased 65% between baseline (44 infections during 365,809 patient days) and year 2 (12 infections during 287,847 patient days; P <.001); a significant reduction was observed at each of the LTCFs (P <.03).
  
  
  
  On-site MRSA surveillance with targeted decolonization resulted in a significant decrease in clinical MRSA infection among LTCF residents.
authors: Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL; Department of Pathology, University of Chicago Pritzker School of Medicine, Chicago, IL; Division of Infectious Diseases, Department of Medicine, NorthShore University HealthSystem, Evanston, IL; Division of Microbiology, Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL; Department of Infection Control, NorthShore University HealthSystem, Evanston, IL. Electronic address: lance1@uchicago.edu.
authors: Lance R
authors: LR
authors: Peterson
authors: Division of Microbiology, Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL.
authors: Susan
authors: S
authors: Boehm
authors: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors: Jennifer L
authors: JL
authors: Beaumont
authors: Division of Microbiology, Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL.
authors: Parul A
authors: PA
authors: Patel
authors: Division of Microbiology, Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL.
authors: Donna M
authors: DM
authors: Schora
authors: Division of Microbiology, Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL.
authors: Kari E
authors: KE
authors: Peterson
authors: Lutheran Life Communities, Arlington Heights, IL.
authors: Deborah
authors: D
authors: Burdsall
authors: Department of Infection Control, NorthShore University HealthSystem, Evanston, IL.
authors: Carolyn
authors: C
authors: Hines
authors: Division of Microbiology, Department of Pathology and Laboratory Medicine, NorthShore University HealthSystem, Evanston, IL.
authors: Maureen
authors: M
authors: Fausone
authors: Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL; Division of Infectious Diseases, Department of Medicine, NorthShore University HealthSystem, Evanston, IL; Department of Infection Control, NorthShore University HealthSystem, Evanston, IL.
authors: Ari
authors: A
authors: Robicsek
authors: Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL; Division of Infectious Diseases, Department of Medicine, NorthShore University HealthSystem, Evanston, IL; Department of Infection Control, NorthShore University HealthSystem, Evanston, IL.
authors: Becky A
authors: BA
authors: Smith
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D002710:Chlorhexidine / Q000008:administration & dosage; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008134:Long-Term Care; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D016712:Mupirocin / Q000008:administration & dosage; D011446:Prospective Studies; D012951:Socialization; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D002710:Chlorhexidine
keywords: Long-term care facility (LTCF); MDRO control; decolonization therapy; health care–associated infection; methicillin-resistant Staphylococcus aureus (MRSA); real-time PCR