Universal screening and decolonization for control of MRSA in nursing homes: a cluster randomized controlled study

Area of Science:

• Infectious Diseases
• Public Health
• Geriatric Medicine

Background:

• Nursing home residents have a higher risk of methicillin-resistant Staphylococcus aureus (MRSA) carriage than the general population.
• Effective control strategies for MRSA in nursing homes are not well-defined.
• This study investigated the impact of enhanced MRSA control measures in nursing homes.

Purpose of the Study:

• To compare the effectiveness of standard precautions alone versus standard precautions combined with MRSA screening and decolonization.
• To determine if universal screening and decolonization reduce MRSA carriage rates in nursing homes.

Main Methods:

• A cluster randomized controlled trial was conducted in nursing homes in Vaud, Switzerland.
• 104 nursing homes participated, randomly assigned to either a control group (standard precautions) or an intervention group (standard precautions plus screening and decolonization).
• MRSA screening was performed at baseline and 12 months, with decolonization for identified carriers in the intervention group.

Main Results:

• The prevalence of MRSA carriage at baseline was similar in both groups (approximately 8.9%).
• After 12 months, MRSA carriage rates declined in both groups to 6.6% (control) and 5.8% (intervention).
• The decline in MRSA carriage rates did not significantly differ between the intervention and control groups (P=.66).

Conclusions:

• Universal MRSA screening followed by decolonization of carriers did not significantly reduce MRSA carriage rates at one year compared to standard precautions.
• Current strategies may not be sufficient to control MRSA in nursing home settings.
• Further research into optimized MRSA control interventions for nursing homes is warranted.