Methicillin-resistant S. aureus (MRSA) is an opportunistic pathogen and an important cause of healthcare-associated infections. MRSA is transmitted through direct or indirect contact in the healthcare setting. In acute care settings, we use Contact Precautions (health care workers [HCW] wear gowns and gloves for all patient contact) for patients colonized with MRSA to prevent transmission to other patients. Current Centers for Disease Control and Prevention (CDC) Isolation Guidelines suggest modifying Contact Precautions in long term care facilities (LTCF), but there is little evidence to guide how to modify them. The goal of this project is to develop an intervention to minimize MRSA transmission in community-based LTCF. We will determine the optimal modifications of Contact Precautions for LTCF in order to reduce the risk of MRSA transmission and allow care in a home-like, patient-centered environment. LTCFs provide multiple levels of care including rehabilitation care, skilled nursing care and maintenance care. In the PI's current VA Merit award, we demonstrated that MRSA transmission is four fold higher in rehabilitation care than maintenance care. This suggests that the types of care delivered modify the risk of transmission. Recently we developed a novel surrogate measure of MRSA transmission, detection of MRSA on HCW gown and gloves during HCW-patient interaction. Using this new methodology, we will test the hypothesis that MRSA transmission will vary significantly by type of contact (e.g. catheter or drain care) in community-based long term care facilities.
Our first aim i s to estimate the frequency of and risk factors for MRSA transmission to protective gowns worn by HCW interacting with MRSA colonized LTC residents using an observational study.
Our second aim i s to estimate the cumulative risk of MRSA transmission to protective gowns worn by HCW interacting with MRSA colonized LTC residents in rehabilitation care, skilled nursing care and maintenance care to assess different modifications to Contact Precautions in long term care facilities using mathematical models.
Our third aim i s to estimate the costs of these different modifications to Contact Precautions using activity- based costing. The results of our proposed study will improve the quality of care in community-based LTCF by providing evidence for when protective gowns are needed.

Public Health Relevance

Methicillin-resistant S. aureus (MRSA) is an important cause of healthcare-associated infections. These are infections that patients acquire during the course of receiving treatment for other conditions within the health care system. Preventing MRSA transmission and infections is an important quality of care goal for healthcare systems. MRSA colonization is more common in long term care facilities than in acute care hospitals;however, the optimal infection control precautions to prevent MRSA transmission in long term care facilities are unknown. The goal of this project is to develop an intervention which minimizes MRSA transmission in LTCF and allows care in a home-like, patient- centered environment.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18HS019979-02
Application #
8307729
Study Section
Health Care Quality and Effectiveness Research (HQER)
Program Officer
Cleeman, James
Project Start
2011-08-01
Project End
2014-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
2
Fiscal Year
2012
Total Cost
Indirect Cost
Name
University of Maryland Baltimore
Department
Public Health & Prev Medicine
Type
Schools of Medicine
DUNS #
188435911
City
Baltimore
State
MD
Country
United States
Zip Code
21201
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