Integrating Personal and Household Environmental Hygiene Measures to Prevent Methicillin-Resistant Staphylococcus aureus Infection

结合个人及家居环境卫生措施预防耐甲氧西林金黄色葡萄球菌感染

• 批准号: 9133346
• 负责人: Stephanie Ann Fritz
• 金额: $ 49.97万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9133346
• 关键词: Integrating; Personal; Household; Environmental; Hygiene

 DESCRIPTION (provided by applicant): The community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) epidemic poses a significant health and economic burden. As CA-MRSA is now the predominant MRSA clone in the community and in many healthcare settings, clinicians and infection prevention specialists face new challenges. The community has become an important and expanding reservoir for the spread of virulent CA-MRSA strains into hospitals, likely increasing the severity of nosocomial MRSA infections. Efforts are needed to mitigate the spread of MRSA in the community and decrease the burden of CA-MRSA infections. Households are significant reservoirs for MRSA transmission and important targets for MRSA eradication. Our prior study demonstrated that a one-time decolonization regimen performed by all household members reduced (but did not eliminate) the incidence of skin and soft tissue infection (SSTI) in index patients and household contacts. Given the widespread dissemination of CA-MRSA and risk for ongoing exposure, a periodic approach to personal decolonization may provide sustained protection against CA-MRSA reacquisition. Additionally, environmental surfaces in households of patients with MRSA infection are frequently and persistently contaminated with MRSA; thus, decontamination of household surfaces may limit the acquisition and spread of MRSA. Pediatric patients with CA-MRSA infection and their household members will be recruited to participate in a pragmatic comparative effectiveness trial evaluating personal and household environmental hygiene strategies to decrease the burden of CA-MRSA disease. Specifically, all participants (index patients and their household contacts) will perform a baseline 5-day MRSA decolonization protocol consisting of enhanced hygiene measures, application of mupirocin antibiotic ointment to the anterior nares twice daily, and daily body washes with chlorhexidine antiseptic. Following the 5-day baseline decolonization regimen, households will be randomized to one of three intervention groups: 1) Periodic personal decolonization performed by all household members, to include chlorhexidine body washes twice weekly for 3 months and application of intranasal mupirocin for 5 consecutive days each month for 3 months; 2) Household environmental hygiene, including targeted cleaning of household surfaces and laundering of bed linens, weekly for 3 months; and 3) Integrated periodic personal decolonization and household environmental hygiene for 3 months. Households will be followed for 9 months to measure the prevalence of MRSA colonization in the participants and the household environment and to document the incidence of recurrent SSTI. Molecular strain typing will be performed on all recovered MRSA isolates to illuminate transmission dynamics. Each recovered MRSA isolate will be tested for resistance to mupirocin, chlorhexidine, and systemic antibiotics. The proposed trial will identify best strategie for curtailing the incidence of CA-MRSA infections, thus reducing healthcare utilization for CA-MRSA treatment, potentially preventing additional migration of virulent CA-MRSA strains into hospitals.

 描述（由适用提供）：与社区相关的耐甲氧西林金黄色葡萄球菌（CA-MRSA）的流行病位置是重要的健康和经济伯恩。由于CA-MRSA现在是社区中主要的MRSA克隆，并且在许多医疗保健环境中，临床医生和感染预防专家都面临着新的挑战。该社区已成为重要且不断扩大的储备，以扩散有毒的CA-MRSA菌株进入医院，这可能会增加医院MRSA感染的严重程度。需要努力来减轻MRSA在社区中的传播，并减少CA-MRSA感染的燃烧。家庭是MRSA传播的重要水库，也是MRSA消除的重要目标。我们先前的研究表明，所有家庭成员都进行了一次性非殖民化方案，均减少（但未消除）指数患者和家庭接触的皮肤和软组织感染（SSTI）的发生。鉴于CA-MRSA的宽度传播和持续暴露的风险，定期进行个人非殖民化方法可以持续保护CA-MRSA的重新审核。此外，MRSA感染患者家庭中的环境表面经常被MRSA污染。因此，家庭表面的去污可能会限制MRSA的获取和传播。患有CA-MRSA感染的小儿患者及其家庭成员将被招募参加一项务实的比较有效性试验，评估了个人和家庭环境卫生策略，以减少CA-MRSA疾病的燃烧。具体而言，所有参与者（指数患者及其家庭接触）将执行5天的MRSA非殖民化协议，该方案包括增强的卫生测量，每天两次将莫皮罗蛋白抗生素药膏应用于前鼻腔，以及每天用氯己胺抗毒剂进行体外洗涤。遵循5天的基线非殖民化治疗方案，将家庭随机分为三个干预组之一：1）所有家庭成员进行的定期个人非殖民化，包括每周两次洗涤甲甲胺的沐浴露，并在3个月内连续5个月连续5个月施用3个月; 2）每周3个月的家庭环境卫生，包括针对性清洁家庭表面和洗钱床。 3）综合定期非殖民化和家庭环境卫生3个月。将遵循9个月的家庭，以衡量参与者和家庭环境中MRSA殖民化的流行，并记录Recisurrent SSTI的事件。将对所有回收的MRSA分离株进行分子应变键入，以照明透射动力学。每个回收的MRSA分离株都将测试对莫匹洛昔丁，洗涤胺和全身性抗生素的耐药性。拟议的试验将确定减少CA-MRSA感染事件的最佳策略，从而降低用于CA-MRSA治疗的医疗保健利用，从而阻止将有毒的CA-MRSA菌株迁移到医院。