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2080 Implementing and evaluating an evidence-based intervention from the intensive care unit (ICU) setting into primary care using promotoras to reduce CA-MRSA recurrence and household transmission

Published online by Cambridge University Press:  21 November 2018

Brianna M. D’Orazio
Affiliation:
Clinical Directors Network (CDN)
Jonathan N. Tobin
Affiliation:
Clinical Directors Network (CDN)
Rhonda G. Kost
Affiliation:
Clinical Directors Network (CDN)
Chamanara Khalida
Affiliation:
Clinical Directors Network (CDN)
Jessica Ramachandran
Affiliation:
Clinical Directors Network (CDN)
Mina Pastagia
Affiliation:
Clinical Directors Network (CDN)
Teresa H. Evering
Affiliation:
Clinical Directors Network (CDN)
Maria P. de la Gandara
Affiliation:
Clinical Directors Network (CDN)
Cameron Coffran
Affiliation:
The Rockefeller University
Joel Correa da Rosa
Affiliation:
Mount Sinai School of Medicine
Kimberly Vasquez
Affiliation:
The Rockefeller University
Getaw W. Hassen
Affiliation:
Metropolitan Hospital
Franco Barsanti
Affiliation:
Urban Health Plan
Satoko Kanahara
Affiliation:
Community Healthcare Network
Regina Hammock
Affiliation:
Coney Island Hospital
Rosalee Nguyen
Affiliation:
Coney Island Hospital
Mark Trezia
Affiliation:
Coney Island Hospital
Trang Gisler
Affiliation:
MyOwnMed, Inc.
Herminia de Lencastre
Affiliation:
The Rockefeller University
Alexander Tomasz
Affiliation:
The Rockefeller University
Barry S. Coller
Affiliation:
The Rockefeller University
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Abstract

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OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to disseminate, implement and evaluate whether an existing intervention, consisting of decolonization and decontamination procedures, which has been determined to be effective in hospital intensive care unit settings, can be implemented by Community Health Workers (CHWs) or “promotoras” conducting home visits prevent recurrence of CA-MRSA and transmission within their households for patients presenting to primary care with SSTIs. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 4 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants are randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention or usual care, which includes hygiene education. The highly engaged stakeholder team meets monthly to review interim results, identify areas for refinement and new research questions, and develop and implement strategies to improve participant engagement and retention. RESULTS/ANTICIPATED RESULTS: MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively. 59.5% with MRSA+ wound culture had one or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had one or more MSSA+ surveillance culture. The “warm handoff” approach, developed and implemented by the stakeholder team to engage patients from their initial consent to return of lab results and scheduling of the home visits, helped improve completion of baseline home visits by 14%, from 45% to 59% of eligible participants. Home visits have demonstrated that 60% of households had at least one surface contaminated with S. aureus. Of the surfaces that tested positive in the households, nearly 20% were MRSA and 81% were MSSA; 32.5% of household members had at least one surveillance culture positive for S. aureus (MRSA: 7.7%, MSSA: 92.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the systems-level, patient-level, and environmental-level factors associated with SSTI recurrence and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators of implementation of home visits by CHWs in underserved populations, and aims to strengthen the weak evidence base for implementation of strategies to reduce SSTI recurrence and household transmission.

Type
Health Equity & Community Engagement
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Association for Clinical and Translational Science 2018