Research Activities, November-December 2013
Contact precautions should be extended to all MRSA carriers in a nursing home
Patient Safety and Quality
Methicillin-resistant Staphylococcus aureus (MRSA) is a growing problem in hospitals and nursing homes. Current guidelines include recommendations for the use of contact precautions to prevent MRSA transmission in nursing homes. These include moving MRSA carriers to single rooms and using gowns and gloves when handling residents. However, these precautions are usually limited to patients with clinically apparent MRSA infections in the form of wounds or uncontained secretions.
A new study finds that there can be substantial benefit when contact precautions are extended to all known MRSA carriers in nursing homes, not just those with evident infection. Researchers used a computational model that included virtual representations of 71 nursing homes and 29 hospitals to compare three strategies: not applying contact precautions to any nursing home residents, applying contact precautions to individuals with clinically apparent MRSA infections, and using contact precautions for all known MRSA carriers identified by hospital screening.
Implementing contact precautions for those with clinically apparent infection had a minimal effect of less than 1 percent on MRSA prevalence in hospitals, which continued 5 years after starting the practice. The strategy did result in a median 0.4 percent decrease in MRSA prevalence in nursing homes. Using contact precautions on all known MRSA carriers resulted in a 14.2 decrease in MRSA prevalence in nursing homes and a 2.3 percent decrease in hospitals 1 year after implementation.
According to the researchers, the findings support a more comprehensive approach to contain and prevent MRSA infection. They suggest that nursing homes include measures to help residents deal with the isolation requirement of contact precautions. The study was supported in part by AHRQ (Contract No. 290-05-0033).
See "The potential regional impact of contact precaution use in nursing homes to control methicillin-resistant Staphylococcus aureus," by Bruce Y. Lee, M.D., M.B.A., Ashima Singh, M.S., Sarah M. Bartsch, M.P.H., and others in the February 2013 Infection Control and Hospital Epidemiology 34(2), pp. 151-160.