The longitudinal prevalence of MRSA in care home residents and the effectiveness of improving infection prevention knowledge and practice on colonisation using a stepped wedge study design

Abstract

ObjectivesTo determine the prevalence and health outcomes of meticillin-resistant Staphylococcus aureus (MRSA) colonisation in elderly care home residents. To measure the effectiveness of improving infection prevention knowledge and practice on MRSA prevalence.SettingCare homes for elderly residents in Leeds, UK.ParticipantsResidents able to give informed consent.DesignA controlled intervention study, using a stepped wedge design, comprising 65 homes divided into three groups. Baseline MRSA prevalence was determined by screening the nares of residents (n=2492). An intervention based upon staff education and training on hand hygiene was delivered at three different times according to group number. Scores for three assessment methods, an audit of hand hygiene facilities, staff hand hygiene observations and an educational questionnaire, were collected before and after the intervention. After each group of homes received the intervention, all participants were screened for MRSA nasal colonisation. In total, four surveys took place between November 2006 and February 2009.ResultsMRSA prevalence was 20%, 19%, 22% and 21% in each survey, respectively. There was a significant improvement in scores for all three assessment methods post-intervention (p≤0.001). The intervention was associated with a small but significant increase in MRSA prevalence (p=0.023). MRSA colonisation was associated with previous and subsequent MRSA infection but was not significantly associated with subsequent hospitalisation or mortality.ConclusionsThe intervention did not result in a decrease in the prevalence of MRSA colonisation in care home residents. Additional measures will be required to reduce endemic MRSA colonisation in care homes.

A methicillin-rezisztens Staphylococcus aureus gyakorisága és kockázati tényezői a bentlakásos szociális intézményekben. Nemzetközi kitekintés

“…23 269 ellátott orr-, sebváladéká-ból és/vagy perianalis törletéből végzett mikrobiológiai vizsgálatok alapján az MRSA-prevalencia értéke 17,7% (terjedelem: 4,7-58,6%) . A közlemények alapján Észak-Amerikában az MRSA előfordulása háromszor gyakoribb, 33,9% (16,,6%), mint az európai bentlakásos szociális intézményekben, ahol az átlagos prevalencia 12,6% (4,7-22,5%) .…”

Keeping an eye on the context: participatory development of eHealth to support clinical practice

“…Most studies, 24 out of 29, combined different elements [9-25, 27, 28, 30, 32-45]. In five studies the implementation strategy consisted of one component [26,29,31,36,37]. The strategies used are summarized below:…”

“…Thus, we argue that practical issues regarding implementation in guideline effectiveness studies are needed, even though findings regarding adherence and uptake of guidelines are usually not the main findings of interest for clinicians. Opening this black box via studies that describe and assess the effectiveness of the implementation strategies studies such as some of the publications in our review, are needed urgently [34][35][36][37].…”

“…HCW screening was implemented only as part of a bundle of measures, in one study [25]. Patient isolation was implemented as stand-alone measure in one study [36], and was part of a bundle of measures in five studies [11,14,24,26,27].…”

“…In this sense, high tech is valuable, but applying a human touch to technology is of paramount importance to enable adherence [36] and a fit with practice. A great challenge remains in how to weigh needs and involve the right stakeholders in technology development.…”