Intervention to Reduce the Incidence of Methicillin-Resistant<i>Staphylococcus aureus</i>Skin Infections in a Correctional Facility in Georgia

Wootton, Susan H.; Arnold, Kathryn E.; Hill, Holly A.; McAllister, Sigrid K.; Ray, Marsha; Kellum, Molly; LaMarre, Madie; Lane, Mary Ellen; Chaitram, Jasmine; Lance-Parker, Susan; Kuehnert, Matthew J.

doi:10.1086/502413

Cited by 41 publications

(31 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For detainees with MRSA skin lesions, a standardized antimicrobial regimen was prescribed, intranasal mupirocin and/or oral rifampin was given for decolonization, and careful attention was paid to dressing changes. With these interventions, the incidence of MRSA SSTIs decreased from 11.6 to 0 per 10,000 detainee-days (1008). The introduction of such a multiplicity of interventions, while apparently effective at curtailing an outbreak, may not be universally practical in jails and prisons.…”

Section: Specific Populationsmentioning

confidence: 99%

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

2010

View full text Add to dashboard Cite

SUMMARY Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.

show abstract

Section: Specific Populationsmentioning

confidence: 99%

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

2010

View full text Add to dashboard Cite

show abstract

“…Among military personnel, infection rates are highest in trainees (4, 5). Because SSTI can interrupt training cycles and compromise operational readiness, effective SSTI prevention strategies for military populations are critically needed.In the absence of a vaccine for Staphylococcus aureus, hygienebased measures (e.g., hand washing, appropriate wound care, environmental disinfection, and patient education) comprise the current strategy for stemming SSTI outbreaks and preventing new cases of disease (1,3,6). As colonization has a demonstrated role in the pathogenesis and transmission of S. aureus, elimination of the carrier state with topical and systemic agents also has been employed as a prevention strategy (7-10).…”

mentioning

confidence: 99%

Frequent Use of Chlorhexidine-Based Body Wash Associated with a Reduction in Methicillin-Resistant Staphylococcus aureus Nasal Colonization among Military Trainees

Millar

Chen

Schlett

et al. 2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

In a field-based trial among military trainees, personal hygiene measures, including chlorhexidine (CHG) body wash, did not prevent overall and methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTI). We conducted a secondary analysis of anterior nares cultures obtained during the trial to evaluate the impact of hygiene measures on Staphylococcus aureus colonization. A cluster-randomized trial for SSTI prevention was conducted among U.S. Army infantry trainees from May 2010 to January 2012. There were three study groups with incrementally increasing education-and hygiene-based components: standard (S), enhanced standard (ES), and CHG. Anterior nares cultures were obtained from participants to determine the prevalence of S. aureus colonization. A total of 1,706 participants (469 S, 597 ES, and 640 CHG) without SSTI were included in the colonization analysis. Of those randomized to the CHG group, 360 (56.3%) reported frequent use of body wash. Frequent use of body wash had no effect on overall S. aureus colonization (53.3% versus 56.8% among infrequent/nonusers; P ‫؍‬ 0.25). MRSA colonization prevalence was marginally lower among frequent users (2.5% versus 4.7%; P ‫؍‬ 0.07). In multivariable analysis, the odds of MRSA colonization were lower among frequent users (odds ratio [ Skin and soft-tissue infections (SSTI), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), have become increasingly common in communities. Individuals in congregate settings (e.g., athletes, inmates, and military personnel) are known to be at increased risk for SSTI (1-3). Among military personnel, infection rates are highest in trainees (4, 5). Because SSTI can interrupt training cycles and compromise operational readiness, effective SSTI prevention strategies for military populations are critically needed.In the absence of a vaccine for Staphylococcus aureus, hygienebased measures (e.g., hand washing, appropriate wound care, environmental disinfection, and patient education) comprise the current strategy for stemming SSTI outbreaks and preventing new cases of disease (1,3,6). As colonization has a demonstrated role in the pathogenesis and transmission of S. aureus, elimination of the carrier state with topical and systemic agents also has been employed as a prevention strategy (7-10). Nevertheless, the optimal method to prevent SSTI in congregate settings remains unknown.To date, two field-based randomized controlled trials for SSTI prevention, both using chlorhexidine gluconate (CHG), have been conducted among U.S. military trainees (11,12). Among recruits attending Officer Candidate School at Marine Corps Base, Quantico, Virginia, a thrice-weekly application of CHG-impregnated body cloths over a 6-week period did not reduce rates of SSTI (11). With respect to colonization, however, an analysis of nasal/axillary swabs showed a significant reduction in MRSA acquisition rates among CHG-randomized participants compared to the control (3.3% versus 6.5%; P ϭ 0.004) (13). More import...

show abstract

“…(106; 215) Personal hygiene is believed to play a major role in SSTI and MRSA-SSTI and is considered an important measure for limiting its spread. (215) Chlorhexidine gluconate wash Chlorhexidine gluconate (CHG) has been used as an antimicrobial agent for a number of years. Its bactericidal activity is dependent on its concentration; most chlorhexidine hand wash products come in 2-4% concentrations.…”

Section: Hygiene-based Preventionmentioning

confidence: 99%

Cost Effectiveness Analysis of Hygiene-Based Strategies Aimed Toward Prevention of SSTI and MRSA-Associated SSTI Among U.S. Active Duty Army Trainees

Morrison¹

2015

View full text Add to dashboard Cite

iii ACKNOWLEDGMENTSThere are many individuals and organizations that I would like to thank. Without your support this research would never have come to fruition. To the many family and friends that have supported me through the course of this multi-year process, I thank you. To my late father, thanks for believing in me and pushing me to be the very best of myself. The many early struggles were worth it. COPYRIGHT STATEMENTThe author hereby certifies that the use of any copyrighted material in the dissertation manuscript entitled: Cost effectiveness of hygiene strategies aimed toward prevention of SSTI and MRSA-associated SSTI aniong U.S. active duty Army trainees is appropriately acknowledged and, beyond brief excerpts, is with the permission of the copyright owner.[Signature]Stephanie M. Morrison Military health systems datasets were used to retrospectively evaluate lost-time in training and cost burden of overall, S.aureus and MRSA SSTI. ICD-9-CM codes were used to identify skin and soft tissue infections, these codes were then linked with clinical microbiology information to identify S.aureus and MRSA SSTI. Lost time in training was calculated as the sum of time spent away from training due to clinic or hospital visits as well as convalescence and training remediation. Cost of illness was equivalent to the sum of direct medical costs (costs associated with medical care such as office visits, laboratory procedures, and prescriptions) and indirect costs (costs associated with lost work productivity because of illness). A systematic review of the literature was performed to determine the effects of hand and personal hygiene programs aimed toward acute infections like SSTI in terms of risk reduction. Additionally, the cost effectiveness of hygiene strategies aimed toward overall and MRSA SSTI among recruit trainees was evaluated using information obtained from a prospective trial implemented at Fort Benning, Georgia. A decision analysis framework was constructed and cost effectiveness was computed using the costs averted and time averted when using a certain strategy compared to standard practice along the infection pathway. Complicated infections contributed to increased rates, lost time in training, and costs.Increased lost time and costs was observed among those trainees with an overall SSTI who were cultured positive for MRSA, received an I&D procedure and prescribed an antibiotic regimen that covered for MRSA.A systematic review and meta-analysis of the literature revealed that hand and personal hygiene promotions programs had a beneficial effect toward acute communicable infections like gastrointestinal, respiratory, and skin infections. Further analysis revealed that significant heterogeneity existed around the pooled risk ratios, the source of which was not identified. Although a chlorhexidine strategy with a hygiene component was shown to be protective against SSTI within the community, results should be viewed with caution. The studies used to generate this pooled estimate were observational-analytic b...

show abstract

Intervention to Reduce the Incidence of Methicillin-ResistantStaphylococcus aureusSkin Infections in a Correctional Facility in Georgia

Abstract: MRSA skin disease can become an emergent problem in a correctional facility. Interventions targeted at skin disease screening, appropriate antimicrobial treatment, and hygiene may decrease the risk of acquiring MRSA infection in correctional facilities.

Cited by 41 publications

References 4 publications

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Frequent Use of Chlorhexidine-Based Body Wash Associated with a Reduction in Methicillin-Resistant Staphylococcus aureus Nasal Colonization among Military Trainees

Cost Effectiveness Analysis of Hygiene-Based Strategies Aimed Toward Prevention of SSTI and MRSA-Associated SSTI Among U.S. Active Duty Army Trainees

Contact Info

Product

Resources

About