To 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.
Care homes for elderly residents in Leeds, UK.
Residents able to give informed consent.
A 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.
MRSA 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.
The 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.
To assess the effectiveness of an educational intervention on the prevalence of MRSA in care homes for the older people.
There was a high rate of MRSA colonisation in elderly residents of care homes during the study period.
The intervention improved the infection prevention knowledge and practice of staff working in care homes but did not reduce the prevalence of MRSA colonisation of residents.
MRSA colonisation was associated with previous and subsequent MRSA infection but was not significantly associated with subsequent hospitalisation or mortality.
Additional measures are required to reduce endemic MRSA colonisation in care homes.
Strengths and limitations of this study
This is a large prospective study, including 65 homes and 2492 residents. MRSA prevalence was monitored over a 28-month period.
The intervention was plausible, unlikely to be harmful, and the assessments of the intervention were reasonable.
A significant improvement was seen in scores for all three intervention assessment methods; however, the intervention was associated with a small but significant increase in MRSA prevalence.
It was not possible to identify or control for the factors responsible for the increase in MRSA prevalence following the intervention.