APIC 2012: A practical solution to MRSA colonization in long term care

January 12th, 2015

Long-term settings have limited options for isolation measures, as residents need to remain active and interact as a matter of health. Similarly, theoretical decolonization protocols raise a host of other issues, for example, possible mupirocin resistance in methicillin-resistant Staphylococcus aureus (MRSA). A practical solution to this conundrum was devised by infection preventionists at a Canadian geriatric facility, where MRSA transmission dropped a stunning 82% after introduction of a daily bathing protocol with disposable cloths containing chlorhexidine gluconate (CHG). The Acute Care Transition (ACT) unit at Baycrest, a geriatric healthcare system in Ontario, achieved the reduction over a 33-month period, investigators reported at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC). Their results were achieved by daily bathing of patients with wipes containing CHG, a practice that began as a pilot study in the 27-bed ACT unit, which is dedicated to patients with complex sub-acute and chronic conditions that require urgent medical care. Prior to the intervention, there was a MRSA transmission rate of 5 cases per 1,000 patient days. After the intervention was introduced and became a standard of care, that rate was reduced to 0.8 cases per 1,000 patient days – an 82% reduction. It was a single intervention, with no other changes in practice on the unit, a relative oddity in infection control studies that underscores the significance of the findings. The 1,000-bed facility screens every patient on admission to determine whether they are colonized with MRSA, said Heather Candon, MSc., CIC, infection prevention and control practitioner at Baycrest said. The impetus for the bathing intervention was finding that 21% of the facility’s MRSA transmission was occurring in the ACT unit. “Because patients who are colonized with MRSA have a much greater chance of developing a MRSA infection, we knew we needed to intervene to stop transmission and prevent infection,” said Candon. “Use of the CHG cloths proved to be a very effective way to achieve and sustain this reduction.”

Candon added that previous reports had shown that bathing with CHG cloths reduced the risk of infections in patients undergoing surgery, but, to their knowledge, the technique had not yet been studied for reduction of MRSA transmission in a geriatric setting. “The research presented by the Baycrest team represents a potentially promising intervention to reduce MRSA transmission and improve patient safety as part of an overall bundle of infection prevention strategies as identified by a facility’s infection risk assessment,” said Michelle Farber, RN, CIC, APIC 2012 president.