Methicillin-Resistant Staphylococcus Aureus
Conditions
Keywords
Cross infection, Long term care
Brief summary
Methicillin-resistant S. aureus (MRSA) infections are a common cause of morbidity and mortality in nursing home residents. MRSA is predominantly spread from patient-to-patient by health care workers. The use of gowns, gloves and hand washing prevents this spread; however, their use detracts from a patient-centered, home-like environment which is an important priority for nursing homes. The goal of this project is to determine when it is most important for health care workers to wear gowns and to wash their hands when caring for MRSA colonized Veterans in community living centers.
Detailed description
Methicillin-resistant S. aureus (MRSA) infections are a common cause of morbidity and mortality in nursing home residents. MRSA is predominantly spread from patient-to-patient by health care workers. The use of gowns, gloves and hand washing prevents this spread; however, their use detracts from a patient-centered, home-like environment which is an important priority for nursing homes. The goal of this project is to determine when it is most important for health care workers to wear gowns and to wash their hands when caring for MRSA colonized Veterans in community living centers. To meet this goal, the investigators will enroll \ 400 MRSA-colonized residents and health care workers from VA community living centers in four states and the District of Columbia. Additionally, the investigators will enroll some non-MRSA colonized residents as control subjects. Each enrolled resident will be followed for 6-25 episodes of care observations over 30 days. During each observation, the investigators will have health care workers wear disposable gowns and gloves during each care activity (e.g. wound dressing) that occurs during the study visit. At the end of each care activity, the investigators will swab the gown and gloves prior to disposing of them. Each swab will be tested for MRSA to determine if MRSA from the resident was transferred to the healthcare worker's gown or gloves during that episode of care. The results of the investigators' analysis will be used to develop new infection control guidelines which balance patient safety and a home-like, patient-centered environment.
Interventions
None listed
Sponsors
VA Office of Research and Development
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Resident: * Age 18 years * Reside in a participating LTCF for rehabilitation, skilled nursing or maintenance care * Expected length of stay of \>4 weeks from enrollment * Written informed consent from participant, or written informed consent from legally authorized representative (LAR) with assent from participant Health Care Worker: * Has direct interaction with participating residents at participating VA Long Term Care Facility (LTCF) * Verbal informed consent
Exclusion criteria
Residents: * None Health Care Worker: * Unable or unwilling to wear protective gown or gloves during healthcare workers (HCW)-resident interaction
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| MRSA Transmission | Will be measured during 6-25 episodes of care interactions scheduled over the 30 days following resident enrollment | Presence of MRSA on gown or gloves worn by enrolled health care worker for research purposes while providing a specific type of care for enrolled resident |
Countries
United States
Participant flow
Pre-assignment details
Three participants withdrew from the study prior to cultures being obtained and were not assigned to a study group.
Participants by arm
| Arm | Count |
|---|---|
| MRSA Colonized Residents colonized with MRSA by culture at study admission | 94 |
| Not MRSA Colonized Residents not colonized with MRSA by culture at study admission | 106 |
| Total | 200 |
Baseline characteristics
| Characteristic | MRSA Colonized | Not MRSA Colonized | Total |
|---|---|---|---|
| Age, Continuous | 73 years STANDARD_DEVIATION 13 | 70 years STANDARD_DEVIATION 13 | 71 years STANDARD_DEVIATION 13 |
| Region of Enrollment United States | 94 participants | 106 participants | 200 participants |
| Sex: Female, Male Female | 2 Participants | 6 Participants | 8 Participants |
| Sex: Female, Male Male | 92 Participants | 100 Participants | 192 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 9 / 94 | 8 / 106 |
Outcome results
Primary
MRSA Transmission
Presence of MRSA on gown or gloves worn by enrolled health care worker for research purposes while providing a specific type of care for enrolled resident
Time frame: Will be measured during 6-25 episodes of care interactions scheduled over the 30 days following resident enrollment
Population: We analyzed the number of gown and glove swabs from HCW interacting with MRSA and non-MRSA colonized residents.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Swabs From Interactions With MRSA Colonized Residents | MRSA Transmission | Proportion of glove swabs with MRSA | 0.20 Proportion of swabs positive for MRSA |
| Swabs From Interactions With MRSA Colonized Residents | MRSA Transmission | Proportion of gown swabs with MRSA | 0.11 Proportion of swabs positive for MRSA |
| Swabs From Interactions With Not MRSA Colonized Residents | MRSA Transmission | Proportion of gown swabs with MRSA | 0.01 Proportion of swabs positive for MRSA |
| Swabs From Interactions With Not MRSA Colonized Residents | MRSA Transmission | Proportion of glove swabs with MRSA | 0.02 Proportion of swabs positive for MRSA |