Control of MRSA in Nursing Homes: Decolonization vs Standard Precautions

Study Overview
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Brief Summary
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The purpose of this study is to determine the better approach between the currently procedure (i.e. standards precautions) and a reinforced strategy to control MRSA transmission in the institutionalized population of nursing homes in Canton of Vaud, Switzerland.

Detailed Description
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MRSA carriage among nursing homes residents of Canton Vaud, Switzerland, is increasing, despite use of standard precautions. Recommendation to prevent MRSA transmission in long term care facilities are lacking. We aim to reinforce the current infection control strategy by general MRSA screening of institutionalised residents and decolonisation of MRSA carriers. Because the uncertainties in the impact of this reinforced strategy, we aim to compare this action to the policy actually applied.

Official Title
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Universal Screening and Decolonization vs Standard Precautions for Control of Methicillin-resistant Staphylococcus Aureus (MRSA) in Nursing Homes: a Cluster, Randomised Controlled Study.

Conditions
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Methicillin-Resistant Staphylococcus Aureus

Intervention / Treatment
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* Other: intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: all nursing homes of canton Vaud, Switzerland, that give the consent of participation Exclusion Criteria: - refusal to participate Inclusion criteria for decolonisation in intervention nursing homes: - all MRSA positive residents living in a Nursing Home included in the intervention group Exclusion Criteria for decolonisation: residents that refuse to be screened or refused the decolonisation life expectancy shorter of 7 days known intolerance of disinfectant/ topical antibiotics used in the protocol active MRSA infection asymptomatic MRSA bacteriuria stage IV wound (according to National Pressure Ulcer Advisory Panel)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Standard Precautions<br>control arm, standards precautions for all residents living in the nursing home of control arm, including MRSA carriers | |
| Other: Intervention<br>Intervention arm, standards precautions for all residents living in nursing homes of intervention arm, and topical decolonization for MRSA carriers, including environmental disinfection | Other: intervention<br>* 5 days topical decolonisation including nasal mupirocin tid, chlorhexidine mouth wash tid, chlorhexidine body wash once daily. Daily direct resident's environmental disinfection during decolonisation.<br>* Other names: topical MRSA decolonisation and environmental disinfection;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To determine the change in prevalence of MRSA carriage among residents of each Nursing homes group at the end of the one study year | in each control and intervention nursing home: MRSA screening of all residents of nursing homes of Canton Vaud, at baseline and 1 year later, in order to compare MRSA prevalence changes at nursing homes levels | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To determine the effectiveness of the reinforced strategy to prevent MRSA infection, compared to the standard strategy | In a subpopulation of all nursing homes residents (10% of the whole population), recording of all microbiologically documented MRSA infection, according to nosocomial infection definitions of the Center of Diseases Control (CDC) of Atlanta. | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Methicillin-Resistant Staphylococcus aureus, Decolonisation, Nursing homes, Infection Control