Authors (including presenting author) :
Chao FW (3), Ng YS (1), Ng MF (2), Ng HL (4), Leung Q (8), Kwok WY (3), Chow M (7), Law CC (6), Leung WN (7), Lau YM (3), Au YY (3), Chu P (5), Lee P (5), Choy WK(4)
Affiliation :
(1) Department of Family Medicine & Primary Health Care (2) Department of Medicine and Geriatric, New Territories West Cluster (3) Community Care Division, New Territories West Cluster (4) Department of Clinical Pathology (5) Department of Pharmacy (6) Community Psychiatrics Service (7) Infection Control Team, NTWC (8) Nursing Service Division, NTWC
Introduction :
MRSA carriage is a common occurrence in Residential Care Homes (RCHs), including Residential Care Homes for the Elderly (RCHE) and Residential Care Homes for the Disabled (RCHD), posing a significant risk for silent transmission and the development of MRSA infections. As of March 15, 2024, around 10% of residents in NTWC RCHEs were identified as MRSA positive by RCH staff. To tackle the concerned situation, the Infection Control Team (ICT) and Community Care Division (CCD) have launched a new program which focuses on decolonization therapy for current MRSA carriers within these facilities. The primary objective of this program is to assess the effectiveness of decolonization therapy in reducing MRSA carriage among residents of RCHs.
Objectives :
The pilot program aims to implement a decolonization therapy protocol for MRSA carriers in the NTWC RCHs with the goal of mitigating the transmission of MRSA infections among both residents and staff. The program also assesses the effectiveness and practicality of decolonization therapy within the specific context of these care facilities.
Methodology :
Community Geriatrics Assessment Team (CGAT) Nurses or Community Psychiatric Service (CPS) nurses identify the target group within RCHs by collaborating with RCH staff, residents, and relatives. They obtained consent from the RCH staff, residents, and relatives prior to the decolonization therapy. CGAT or CPS nurses conducted a briefing session for RCH staff, providing information on treatment regimens and methodologies. They also distributed an "information sheet" to RCH staff to aid in their engagement and understanding. They inform CGAT or General Outpatient Clinic (GOPC) Doctors to assess and then prescribe a 5-day decolonization therapy for MRSA carriers without contraindications. The community nurses emphasized the bathing technique to the RCH staff, focusing particularly on the axilla and groin areas through cleansing with 4% Chlorhexidine for 5 days, with emphasis of leaving Chlorhexidine on the body until it bubbled for at least one minute. Residents were advised to change clothing after bathing, while RCH staff should change linen on the first and last days of the treatment. Additionally, CGAT or CPS nurses ensure compliance with the application of 2% Mupirocin nasal ointment three times daily for 5 days and monitor adherence by checking their medication records. Upon completion of the MRSA decolonization therapy, CGAT or CPS nurses will conduct MRSA clearance checks by obtaining specimens from the nasal, axilla and groin areas to confirm the therapy's effectiveness. ICT Nurses manage screening outcomes, removing MRSA alerts after two consecutive negative cultures within 48-hour intervals, and communicate accordingly with CGAT or CPS nurses. This program will be ongoing process for newly diagnosed MRSA carriers or those who were not successful in removing MRSA after the initial treatment.
Result & Outcome :
The pilot phase covered 20 subvented RCHEs and 3 RCHDs, showing a 49% to 76% success rate post-treatment. Phase 2 for RCHEs (43% success) and RCHDs (80% success) is ongoing. The program has been well recognized and appreciated by RCH staff, residents, relatives, and hospital staff. Successful decolonization had enabled the discontinuation of contact precautions for the residents, granting them the freedom to move within their care homes, benefiting both staff and residents. Furthermore, it diminishes the likelihood of subsequent MRSA infections and the further spread of MRSA to other individuals in the RCHs, hospitals, and the community. The initiative is set to be implemented across all RCHEs in the district. Ongoing evaluation will provide updates on the success rate of MRSA carriage clearance following decolonization therapy, with results to be shared in the near future.
