The potential regional impact of contact precaution use in nursing homes to control methicillin-resistant Staphylococcus aureus.

TitleThe potential regional impact of contact precaution use in nursing homes to control methicillin-resistant Staphylococcus aureus.
Publication TypeJournal Article
Year of Publication2013
AuthorsLee BY, Singh A, Bartsch SM, Wong KF, Kim DS, Avery TR, Brown ST, Murphy CR, S Yilmaz L, Huang SS
JournalInfect Control Hosp Epidemiol
Volume34
Issue2
Pagination151-60
Date Published2013 Feb
ISSN1559-6834
KeywordsCalifornia, Cross Infection, Disease Outbreaks, Hospitals, Humans, Methicillin-Resistant Staphylococcus aureus, Models, Theoretical, Nursing Homes, Staphylococcal Infections
Abstract

OBJECTIVE: Implementation of contact precautions in nursing homes to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission could cost time and effort and may have wide-ranging effects throughout multiple health facilities. Computational modeling could forecast the potential effects and guide policy making.DESIGN: Our multihospital computational agent-based model, Regional Healthcare Ecosystem Analyst (RHEA).SETTING: All hospitals and nursing homes in Orange County, California.METHODS: Our simulation model compared the following 3 contact precaution strategies: (1) no contact precautions applied to any nursing home residents, (2) contact precautions applied to those with clinically apparent MRSA infections, and (3) contact precautions applied to all known MRSA carriers as determined by MRSA screening performed by hospitals.RESULTS: Our model demonstrated that contact precautions for patients with clinically apparent MRSA infections in nursing homes resulted in a median 0.4% (range, 0%-1.6%) relative decrease in MRSA prevalence in nursing homes (with 50% adherence) but had no effect on hospital MRSA prevalence, even 5 years after initiation. Implementation of contact precautions (with 50% adherence) in nursing homes for all known MRSA carriers was associated with a median 14.2% (range, 2.1%-21.8%) relative decrease in MRSA prevalence in nursing homes and a 2.3% decrease (range, 0%-7.1%) in hospitals 1 year after implementation. Benefits accrued over time and increased with increasing compliance.CONCLUSIONS: Our modeling study demonstrated the substantial benefits of extending contact precautions in nursing homes from just those residents with clinically apparent infection to all MRSA carriers, which suggests the benefits of hospitals and nursing homes sharing and coordinating information on MRSA surveillance and carriage status.

DOI10.1086/669091
Alternate JournalInfect Control Hosp Epidemiol
PubMed ID23295561
PubMed Central IDPMC3763186
Grant List1U01GM076672 / GM / NIGMS NIH HHS / United States
5U54GM088491-02 / GM / NIGMS NIH HHS / United States
U01 GM076672 / GM / NIGMS NIH HHS / United States
U54 GM088491 / GM / NIGMS NIH HHS / United States
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