Abstract
BACKGROUND: We conducted a decolonization program for methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter (CRA) among residential care homes for the elderly (RCHE) residents by providing universal decolonization using nasal povidone-iodine and chlorhexidine baths at the RCHEs and during hospitalization. OBJECTIVES: 1. To investigate the effectiveness of decolonization of MRSA and CRA in elderly homes. 2. To assess the incidence of MRSA and CRA infections bacteremia, associated morbidity and mortality in elderly homes. 3. To investigate MRSA infection reduction and risk ratio amongst the elderly residents. STUDY DESIGN: This quality improvement program adopted a quasi-experimental design. METHODS: A total of 20,741 RCHE residents were instructed to apply 10 % povidone-iodine nasal ointment once daily, Monday to Friday, every alternate week, while 2 % chlorhexidine gluconate solution was used for bathing on alternate days. Group 1 included RCHE residents who underwent decolonization at the RCHEs and during hospitalization, whereas Group 2 received decolonization at the RCHEs only. The residents who stayed in the RCHEs other than the 330 invited residents RCHEs were considered the control group when they admitted to their network hospitals. We compared the incidence of any MRSA and CRA infections, bacteremia, and associated death in 2023 with the rates during the baseline period from 2017 to 2019, using Poisson exact test. RESULTS: A total of 257/330 (77.9 %) RCHEs continued the program, involving 16,190 residents. The mean utilization of povidone-iodine ranged from 79.4 % to 96.2 %, whereas chlorhexidine utilization ranged from 79.9 % to 97.2 %. MRSA infection was reduced in Group 1 with a risk ratio of 0.878 (95 %CI: 0.776-0.992, p = 0.035) compared with that at baseline. For bacteremia, larger reductions were noted in Group 1 and Group 2, with risk ratios of 0.719 (95 %CI: 0.448-1.115, p = 0.158) and 0.721 (95 %CI: 0.418-1.192, p = 0.207), respectively, compared to the control 0.785 (95 %CI: 0.621-0.984, p = 0.036). Regarding mortality associated with MRSA, a differential reduction of 51.1 %, 18.7 % and 22.2 % were observed for Group 1, Group 2 and the control respectively. For CRA, no statistically significant reduction was detected in the intervention groups for infection, bacteremia or death. CONCLUSIONS: We demonstrated a reduction in hospital admissions due to MRSA infections following the decolonization program for residents in RCHEs and during hospitalization.