Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial.

BACKGROUND: Whole-body washing with antiseptic solution has been widely used as part of eradication treatment for colonization with methicillin-resistant Staphylococcus aureus (MRSA), but evidence for the effectiveness of this measure is limited. OBJECTIVE: To study the efficacy of whole-body washing with chlorhexidine for the control of MRSA. DESIGN: Randomized, placebo-controlled, double-blinded clinical trial. SETTING: University Hospital of Heidelberg and surrounding nursing homes. PATIENTS: MRSA carriers who were not treated concurrently with antibiotics effective against MRSA were eligible for the study. INTERVENTION: Five days of whole-body washing with either 4% chlorhexidine solution (treatment group) or with a placebo solution. All patients received mupirocin nasal ointment and chlorhexidine mouth rinse. The outcome was evaluated 3, 4, 5, 9, and 30 days after treatment with swab samples taken from several body sites. RESULTS: Of 114 patients enrolled in the study (56 in the treatment group and 58 in the placebo group), 11 did not finish treatment (8 from the treatment group and 3 from the placebo group [P=.02]). At baseline, the groups did not differ with regard to age, sex, underlying condition, site of MRSA colonization, or history of MRSA eradication treatment. Eleven patients were MRSA-free 30 days after treatment (4 from the treatment group and 7 from the placebo group [P=.47]). Only groin-area colonization was significantly better eradicated by the use of chlorhexidine. The best predictor for total eradication was a low number of body sites positive for MRSA. Adverse effects were significantly more frequent in the treatment group than in the placebo group (any symptom, 71% vs 33%) but were reversible in most cases. CONCLUSION: Whole-body washing can reduce skin colonization, but it appears necessary to extend eradication measures to the gastrointestinal tract, wounds, and/or other colonized body sites if complete eradication is the goal.

Characteristics that promote transmission of Staphylococcus aureus nursing homes in German nursing homes.

OBJECTIVE: To determine factors that influence transmission of Staphylococcus aureus in nursing homes in the Rhine-Neckar region of southern Germany. DESIGN: Ecologic study. SETTING: Forty-seven nursing homes in the region. PARTICIPANTS: Residents of the approached nursing homes who agreed to participate. METHODS: Personal data and swabs of the nares were collected from participants. Swabs were examined for growth of S. aureus. All S. aureus isolates were typed using pulsed-field gel electrophoresis (PFGE). Transmission rates were calculated by dividing the number of transmissions (ie, cases in which two inhabitants shared the same PFGE type) by the number of S. aureus carriers. Characteristics of the nursing homes were correlated with a home's transmission rate. RESULTS: In each nursing home, 12% to 54% of the residents were colonized with S. aureus. The transmission rates for the 47 nursing homes ranged from 0% to 70%. A linear regression model revealed that a stay in the nursing home of longer than 6 months and accommodation in a room with 3 or more beds were positively associated with the transmission rate. Receipt of antibiotics during the 4 weeks preceding the study was negatively associated with transmission. CONCLUSIONS: Stays beyond 6 months and accommodation in rooms with multiple beds are important for the transmission of S. aureus. One way to reduce transmission would be to design facilities with single and double rooms. However, the social needs of the residents must be evaluated and respected.

Risk factors for methicillin-resistant Staphylococcus aureus carriage in residents of German nursing homes.

OBJECTIVES: To determine the prevalence of and the risk factors for methicillin-resistant Staphylococcus aureus (MRSA) carriage in nursing home residents in the Rhine-Neckar region of southern Germany. DESIGN: Point-prevalence survey. SETTING: Forty-seven nursing homes in the region. PARTICIPANTS: All residents of the approached nursing homes who agreed to participate. METHODS: After informed consent was obtained, all participants had their nares swabbed, some personal data collected, or both. All swabs were examined for growth of MRSA. All S. aureus isolates underwent oxacillin susceptibility testing and polymerase chain reaction for demonstration of the mecA gene. All MRSA isolates were typed using pulsed-field gel electrophoresis after digestion with SmaI. RESULTS: Swabs from 3,236 nursing home residents yielded 36 MRSA strains, contributing to a prevalence rate of 1.1%. Significant risk factors for MRSA carriage in the multivariate analysis were the presence of wounds or urinary catheters, limited mobility, admission to a hospital during the preceding 3 months, or stay in a medium-size nursing home. One predominant MRSA strain could be detected in 30 of the 36 MRSA carriers. CONCLUSIONS: The prevalence of MRSA in German nursing homes is still low. These residents seemed to acquire their MRSA in the hospital and transfer it to their nursing home. Apart from well-known risk factors for the acquisition of MRSA, we identified the size of the nursing home as an independent risk factor. This might be due to an increased use of and microbials in nursing homes of a certain size.

[Fundamentals of hygiene in old-age and nursing homes. Recommendations for nursing personnel and for hygiene control by German public health offices]. / Grundlagen der Hygiene in Pflegeheimen - Empfehlungen für das Pflegepersonal und die Hygieneaufsicht des Gesundheitsamtes -

New German legislative ordinances prescribe hygiene control in nursing homes and homes for the aged, e. g. the Law for Protection against Infectious Diseases and in North-Rhine Westphalia the Public Health Law. However, there are as yet no clearly defined standards of hygiene because the special features of nursing homes must be considered when applying the "Guidelines for Hospital Hygiene and Prevention of Infections" issued by the Robert Koch Institute. Hence, specific recommendations are given for hygiene of the hands, disinfection, hygienic treatment care, protective and professional clothing, washing of textiles, central kitchen, disposal of waste, house cleaning and handling of drugs and medicines.