Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Nov 19;2013(11):CD006354.
doi: 10.1002/14651858.CD006354.pub4.

Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people

Carmel Hughes  1 , Michael Tunney, Marie C Bradley
Affiliations

Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people

Carmel Hughes et al. Cochrane Database Syst Rev. .

Abstract

Background: Nursing homes for older people provide an environment likely to promote the acquisition and spread of meticillin-resistant Staphylococcus aureus (MRSA), putting residents at increased risk of colonisation and infection. It is recognised that infection prevention and control strategies are important in preventing and controlling MRSA transmission.

Objectives: To determine the effects of infection prevention and control strategies for preventing the transmission of MRSA in nursing homes for older people.

Search methods: In August 2013, for this third update, we searched the Cochrane Wounds Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Database of Abstracts of Reviews of Effects (DARE, The Cochrane Library), Ovid MEDLINE, OVID MEDLINE (In-process and Other Non-Indexed Citations), Ovid EMBASE, EBSCO CINAHL, Web of Science and the Health Technology Assessment (HTA) website. Research in progress was sought through Current Clinical Trials, Gateway to Reseach, and HSRProj (Health Services Research Projects in Progress).

Selection criteria: All randomised and controlled clinical trials, controlled before and after studies and interrupted time series studies of infection prevention and control interventions in nursing homes for older people were eligible for inclusion.

Data collection and analysis: Two review authors independently reviewed the results of the searches. Another review author appraised identified papers and undertook data extraction which was checked by a second review author.

Main results: For this third update only one study was identified, therefore it was not possible to undertake a meta-analysis. A cluster randomised controlled trial in 32 nursing homes evaluated the effect of an infection control education and training programme on MRSA prevalence. The primary outcome was MRSA prevalence in residents and staff, and a change in infection control audit scores which measured adherence to infection control standards. At the end of the 12 month study, there was no change in MRSA prevalence between intervention and control sites, while mean infection control audit scores were significantly higher in the intervention homes compared with control homes.

Authors' conclusions: There is a lack of research evaluating the effects on MRSA transmission of infection prevention and control strategies in nursing homes. Rigorous studies should be conducted in nursing homes, involving residents and staff to test interventions that have been specifically designed for this unique environment.

PubMed Disclaimer

Conflict of interest statement

Carmel Hughes and Michael Tunney were investigators on the study which was included in the 2011 review and this latest version of the review (Baldwin 2010). Mike Smith (author on the original review and first two updates) independently extracted and checked the data on the included study.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

Update of

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

References to studies included in this review

Baldwin 2010 {published data only}
    1. Baldwin NS, Gilpin DF, Tunney MM, Kearney MP, Crymble L, Cardwell C, et al. Cluster randomised controlled trial of an infection control education and training intervention programme focusing on meticillin‐resistant Staphylococcus aureus in nursing homes for older people. Journal of Hospital Infection 2011;76(1):36‐41. - PubMed

References to studies excluded from this review

Chami 2012 {published data only}
    1. Chami K, Gavazzi G, Bar‐Hen A, Carrat F, Wazieres B, Lejeune B, et al. A short‐term, multicomponent infection control program in nursing homes: a cluster randomized controlled trial. Journal of the American Medical Directors' Association 2012;13(6):569.e9‐569.e17. - PubMed
Ho 2012 {published data only}
    1. Ho M‐L, Seto W‐H, Wong L‐C, Wong T‐Y. Effectiveness of multifacted hand hygiene interventions on long‐term care facilities in Hong Kong: a cluster‐randomized controlled trial. Infection Control and Hospital Epidemiology 2012;33(8):761‐767. - PubMed
Horner 2012 {published data only}
    1. Horner C, Wilcox M, Barr B, Hall D, Hodgson G, Parnell P, et al. The longitudinal prevalence of MRSA in care home residents and the effectiveness of improving infection prevention knowledge and practice on colonisation using a stepped wedge study design. BMJ Open 2012;2:e000423. - PMC - PubMed

Additional references

Baldwin 2009
    1. Baldwin NS, Gilpin DF, Hughes CM, Kearney MP, Gardiner DA, Cardwell C, et al. Prevalence of meticillin‐resistant Staphylococcus aureus (MRSA) colonization among residents and staff in nursing homes in Northern Ireland. Journal of the American Geriatrics Society 2009;57(4):620‐6. - PubMed
Bradley 1997
    1. Bradley SF. Methicillin‐resistant Staphylococcus aureus in nursing homes. Epidemiology, prevention and management. Drugs and Aging 1997;10(3):185‐98. - PubMed
Burke 2003
    1. Burke JP. Infection control‐a problem for patient safety. New England Journal of Medicine 2003;348(7):651‐6. - PubMed
Campbell 2007
    1. Campbell NC, Murray E, Darbyshire J, Emery J, Farmer A, et al. Designing and evaluating complex interventions to improve health care. BMJ 2007;334(7591):455‐9. - PMC - PubMed
Capitano 2003
    1. Capitano B. Leshem OA, Nightingale CH, Nicolau DP. Cost effect of managing methicillin‐resistant Staphylococcus aureus. Journal of the American Geriatrics Society 2003;51(1):10‐6. - PubMed
Castle 2005
    1. Castle NG, Engberg J. Staff turnover and quality of care in nursing homes. Medical Care 2005;43(6):616‐26. - PubMed
Chamchod 2012
    1. Chamchod F, Ruan S. Modeling the spread of Methicillin‐resistant Staphylococcus aureus in nursing homes for the elderly. PLoS One 2012;7(1):e29757. [DOI: 10.1371/journal.pone.0029757] - DOI - PMC - PubMed
Coia 2006
    1. Coia JE, Duckworth GJ, Edwards DI, Farrington M, Fry C, Humphreys H, et al. Guidelines for the control and prevention meticillin‐resistant Staphylococcus aureus (MRSA) in healthcare facilities. Journal of Hospital Infection 2006;63S:S1‐S44. - PubMed
Cooper 2003
    1. Cooper BS, Stone SP, Kibbler CC, Cookson BD, Roberts JA, Medley GF, et al. Systematic review of isolation policies in the hospital management of methicillin‐resistant Staphylococcus aureus: a review of the literature with epidemiological and economic modelling. Health Technology Assessment 2003;7(39):1‐194. - PubMed
Cosgrove 2003
    1. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y. Comparison of mortality associated with methicillin‐resistant and methicillin‐susceptible Staphylococcus aureus bacteremia: a meta‐analysis. Clinical Infectious Diseases 2003;36(1):53‐9. - PubMed
Cox 1999
    1. Cox RA, Bowie PE. Methicillin‐resistant Staphylococcus aureus colonization in nursing home residents: a prevalence study in Northamptonshire. Journal of Hospital Infection 1999;43:115‐22. - PubMed
Dept of Health 2006
    1. Department of Health. Infection Control Guidance for Care Homes. Department of Health, London 2006.
Drinka 2004
    1. Drinka PJ, Gauerke C, Le D. Antimicrobial use and meticillin‐resistant Staphylococcus aureus in a large nursing home. Journal of the American Medical Directors Association 2004;5(4):256‐8. - PubMed
Elon 1992
    1. Elon R, Pawlson LG. The impact of OBRA on medical practices within nursing facilities. Journal of the American Geriatrics Society 1992;40(9):958‐63. - PubMed
EPOC 2009
    1. Cochrane Effective Practice and Organisation of Care Group. EPOC Working Paper on presentation of data. http://www.epoc.cochrane.org/en/handsearchers.html (Accessed 8 September 2009).
Fraise 1997
    1. Fraise AP, Mitchell K, O'Brien SJ, Oldfield K, Wise R. Methicillin‐resistant Staphylococcus aureus (MRSA) in nursing homes in a major UK city: an anonymized point prevalence survey. Epidemiology and Infection 1997;118(1):1‐5. - PMC - PubMed
Global 1999
    1. Global Consensus Conference on Infection Control Issues Related to Antimicrobial Resistance 1999. Global Consensus Conference: Final recommendations. American Journal of Infection Control 1999;27:503‐13. - PubMed
Goettsch 2000
    1. Goettsch W, Geubbels E, Wannet W, Hendrix MGR, Wagenvoort JHT, Neeling AJ. MRSA in nursing homes in the Netherlands 1989‐1998: a developing reservoir?. Eurosurveillance 2000;5:28‐31. - PubMed
Gopal 2007
    1. Gopal RG, Michalczyk P, Nayeem N, Walker G, Wigmore L. Prevalence and risk factors for meticillin‐resistant Staphylococcus aureus in adult emergency admissions‐a case for screening all patients?. Journal of Hospital Infection 2007; Vol. 66, issue 1:15‐21. - PubMed
Gould 2010
    1. Gould DJ, Moralejo D, Drey N, Chudleigh JH. Interventions to improve hand hygiene compliance in patient care. Cochrane Database of Systematic Reviews 2010, Issue 9. [DOI: 10.1002/14651858.CD005186.pub3] - DOI - PubMed
Graffunder 2002
    1. Graffunder EM, Venezia RA. Risk factors associated with nosocomial methicillin‐resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. Journal of Antimicrobial Chemotherapy 1999;49(6):999‐1005. - PubMed
Health Stats 2013
    1. Health Statistics Quarterly 2013. Deaths involving MRSA: England and Wales, 2008 to 2012. Health Statistics Quarterly 2013.
Herwaldt 1999
    1. Herwaldt LA. Control of methicillin‐resistant Staphylococcis aureus in the hospital setting. American Journal of Medicine 1999;106(5A):11S‐18S. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Altman DG, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (Editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Hoefnagels 2002
    1. Hoefnagels‐Schuermans A, Niclaes L, Buntinx F, Suetens C, Jans B, Verhaegen J, et al. Molecular epidemiology of methicillin‐resistant Staphylococcus aureus in nursing homes: a cross‐sectional study. Infection Control and Hospital Epidemiology 2002;23:546‐9. - PubMed
Hsu 1991
    1. Hsu CC. Serial survey of methicillin‐resistant Staphylococcus aureus nasal carriage among residents in a nursing home. Infection Control and Hospital Epidemiology 1991;12(7):416‐21. - PubMed
Johnson 2003
    1. Johnson LB, Bhan A, Pawlak J, Manzor O, Saravolatz LD. Changing epidemiology of community‐onset methicillin‐resistant Staphylococcus aureus bacteremia. Infection Control and Epidemiology 2003;24(6):431‐5. - PubMed
Lefebvre 2011
    1. Lefebvre C, Manheimer E, Glanville J, on behalf of the Cochrane Information Retrieval Methods Group. Chapter 6: Searching for studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Lesse 2006
    1. Lesse AJ, Mylotte JM. Clinical and molecular epidemiology of nursing home associated Staphylococcus aureus bacteremia. American Journal of Infection Control 2006;34(10):642‐50. - PubMed
Loeb 2003
    1. Loeb M, Main C, Walker‐Dilks C, Eady A. Antimicrobial drugs for treating methicillin‐resistant Staphylococcus aureus colonization. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD003340] - DOI - PubMed
MacDonald 2004
    1. MacDonald A, Dinah F, MacKenzie D, Wilson A. Performance feedback of hand hygiene, using alcohol gel as the skin decontaminant, reduces the number of inpatients newly affected by MRSA and antibiotic costs. Journal of Hospital Infection 2004;56(1):56‐63. - PubMed
McClean 2012
    1. McClean P, Tunney M, Parsons C, Gilpin D, Baldwin N, Hughes C. Infection control and meticillin‐resistant Staphylococcus aureus decolonization: the perspective of nursing home staff. Journal of Hospital Infection 2012;81:264‐9. - PubMed
Mendelson 2003
    1. Mendelson G, Yearmack Y, Granot E, Ben‐Israel J, Colodner R, Raz R. Staphylococcus aureus carrier state among elderly residents of a long‐term care facility. Journal of the American Medical Directors' Association 2003;4(3):125‐7. - PubMed
Morrow 2012
    1. Morrow E, Griffiths p, Rao GG, Flaxman D. "Somebody else's problem?" Staff perceptions of the courses and control of meticillin‐resistant Staphylococcus aureus. American Journal of Infection Control 2012;39:284‐291. - PubMed
Muder 1997
    1. Muder RR, Brennen C, Drenning SD, Stout JE, Wagener MM. Multiple antibiotic‐resistant gram‐negative bacilli in a long‐term‐care facility: a case‐control study of patient risk factors and prior antibiotic use. Infection Control and Hospital Epidemiology 1997;18:809‐13. - PubMed
Mulhausen 1996
    1. Mulhausen PL, Harrell LJ, Weinberger M, Kochersberger GG, Feussner JR. Contrasting methicillin‐resistant Staphylococcus aureus colonization in Veterans Affairs and community nursing homes. American Journal of Medicine 1996;100:24‐31. - PubMed
Niclaes 1999
    1. Niclaes L, Buntinx F, Banuro F, Lesaffre E, Heyrman J. Consequences of MRSA carriage in nursing home residents. Epidemiology and Infection 1999;122(2):235‐9. - PMC - PubMed
O'Sullivan 2000
    1. O'Sullivan NR, Keane CT. The prevalence of methicillin‐resistant staphylococcus aureus among the residents of six nursing homes for the elderly. Journal of Hospital Infection 2000;45(4):322‐9. - PubMed
OBRA 1987
    1. Omnibus Budget Reconciliation Act 1987 (OBRA 87). Omnibus Budget Reconciliation Act 1987 (OBRA 87). Public Law 100‐203. Subtitle C: Nursing Home Reform Act, Washington DC 1987.
Rubin 1999
    1. Rubin RJ, Harrington CA, Poon Dietrich K, Greene JA, Moiduddin A. The economic impact of Staphylococcus aureus infection in New York City hospitals. Emerging Infectious Diseases 1999;5:9‐17. - PMC - PubMed
Safdar 2002
    1. Safdar N, Maki DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial‐resistant Staphylococcus aureus, Enterococcus, Gram‐negative bacilli, Clostridium difficile and Candida. Annals of Internal Medicine 2002;136:834‐44. - PubMed
Samad 2002
    1. Samad A, Banerjee D, Carbarns N, Ghosh S. Prevalence of methicillin‐resistant Staphylococcus aureus colonization in surgical patients on admission to a Welsh hospital. Journal of Hospital Infection 2002;51(1):43‐6. - PubMed
Sclaes 1997
    1. Sclaes DM, Gerding DN, John JF Jr. Society for Healthcare Epidemiology of America and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infection Control Hospital Epidemiology 1997;18:275‐91. - PubMed
SIGN 2009
    1. Scottish Intercollegiate Guidelines Network (SIGN). Search filters. http://www.sign.ac.uk/methodology/filters.html#random (accessed 29 May 2009).
Simor 2001
    1. Simor AE. Containing methicillin‐resistant S. aureus. Surveillance, control and treatment methods. Postgraduate Medicine 2001;110:43‐8. - PubMed
Smith 2008
    1. Smith CS, Parnell P, Hodgson G, Darby B, Barr B, Tompkins D, et al. Are methicillin‐resistant Staphylococcus aureus that produce Panton‐Valentine leucocidin (PVL) found among residents of care homes?. Journal of Antimicrobial Chemotherapy 2008;62:968‐72. - PubMed
Stelfox 2003
    1. Stelfox HT, Bates DW, Redelmeier DA. Safety of patients isolated for infection control. JAMA 2003;290(14):1899‐905. - PubMed
Stone 2001
    1. Stone SP, Kibbler CC, Bowman C, Stott D. Controlling infection in British nursing homes. BMJ 2001;322:506. - PMC - PubMed
Stone 2007
    1. Stone SP, Cooper BS, Kibbler CC, Cookson BD, Roberts JA, Medley GF, et al. The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection. Journal of Antimicrobial Chemotherapy 2007;59:833‐40. - PubMed
Strausbaugh 1996
    1. Strausbaugh LJ, Crossley KB, Nurse BA, Thrupp LD. Antimicrobial resistance in long‐term‐care facilities. Infection Control and Hospital Epidemiology 1996;17:129‐40. - PubMed
Strausbaugh 2003
    1. Strausbaugh LJ, Sukumar SR, Joseph CL. Infectious disease outbreaks in nursing homes: an unappreciated hazard for frail elderly persons. Clinical Infectious Diseases 2003;36:870‐6. - PubMed
Tarzi 2001
    1. Tarzi S, Kennedy P, Stone S, Evans M. Methicillin‐resistant Staphylococcus aureus: psychological impact of hospitalization and isolation on an older adult population. Journal of Hospital Infection 2001;49:250‐4. - PubMed
Terpenning 1994
    1. Terpenning MS, Bradley SF, Wan JY, Chenoweth CE, Jorgensen KA, Kauffman CA. Colonization and infection with antibiotic‐resistant bacteria in a long‐term care facility. Journal of the American Geriatrics Society 1994;42:1062‐9. - PubMed
Tomic 2004
    1. Tomic V, Sorli PS, Trinkaus D, Sorli J, Widmer AF, Trampuz A. Comprehensive strategy to prevent nosocomial spread of methicillin‐resistant Staphylococcus aureus in a highly endemic setting. Archives of Internal Medicine 2004;164(18):2038‐43. - PubMed
Trick 2001
    1. Trick WE, Weinstein RA, DeMarais P, Kuehnert MJ, Tomaska W, Nathan C, et al. Colonization of skilled‐care facility residents with antimicrobial‐resistant pathogens. Journal of the American Geriatrics Society 2001;49(3):270‐6. - PubMed
Tunney 2006
    1. Tunney MM, Hughes CM, Magee J. Infection control policies and procedures for meticillin‐resistant Staphylococcus aureus in care homes for older people in Northern Ireland: a questionnaire study. British Journal of Infection Control 2006;7:20‐4.
von Baum 2002
    1. Baum H, Schmidt C, Svoboda D, Bock‐Hensley O, Wendt C. Risk factors for methicillin‐resistant Staphylococcus aureus carriage in residents of German nursing homes. Infection Control and Hospital Epidemiology 2002;23(9):511‐15. - PubMed
Vos 2005
    1. Vos MC, Ott A, Verbrugh HA. Successful search‐and‐destroy policy for methicillin‐resistant Staphylococcus aureus in the Netherlands. Journal of Clinical Microbiology 2005;43(4):2034‐5. - PMC - PubMed
Weber 2007
    1. Weber SG, Huang SS, Oriola S, Huskins WC, Noskin GA, Harriman K, et al. Legislative mandates for use of active surveillance cultures to screen for methicillin‐resistant Staphylococcus aureus and vancomycin‐resistant enterococci: Position statement from the Joint SHEA and APIC Task Force. American Journal of Infection Control 2007;35:73‐85. - PubMed
Wertheim 2004
    1. Wertheim HFL, Vos MC, Boelens HAM, Voss A, Vandenbroucke‐Grauls, Meester MHM, et al. Low prevalence of methicillin‐resistant Staphylococcus aureus (MRSA) at hospital admission in the Netherlands: the value of search and destroy and restrictive antibiotic use. Journal of Hospital Infection 2004;56(4):321‐5. - PubMed

Publication types

MeSH terms

LinkOut - more resources