Background: Skin and soft tissue infections (SSTI) may be caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), a bacteria that cannot be eliminated by most antibiotic drugs. Current recommendations for treatment of these infections include surgery to remove any pus, along with an oral antibiotic prescription. Most infections go away in response to antibiotics; however, some infections recur, sometimes because patients come into contact with the same bacteria in the home. Others who live in the home may also contract a similar infection. Patients who have CA-MRSA infections and receive health care from NYC Health Centers told us that they are interested in learning how the bacteria spread and what patients can do to prevent infections from returning and spreading to others.
Objectives: This study will work with a research network of primary care doctors’ offices and Rockefeller University to:
- engage clinicians and their patients in identifying and developing English- and Spanish-language health education materials about CA-MRSA;
- improve the delivery of a home visit program, by community health workers (CHWs)/Promotoras from the health centers, that focuses on patients’ greatest concerns (e.g., infections returning, spreading to others); and
- compare the effectiveness, in preventing reinfection and household transmission, of standard care with and without CHW/Promotora home visits plus household decolonization and decontamination.
Methods: A Patient Stakeholder Advisory Committee (PSAC )including patients and family community members will work alongside clinicians and research staff to develop the home-visit intervention, review decolonization and decontamination approaches, and develop patient education materials. We will recruit 278 patients with CA-MRSA-suspected SSTIs from five health centers. Patients will be randomly assigned to usual care or usual care plus intervention groups.
- Evaluate the effectiveness of a CHW-/Promotora-delivered home intervention as compared to UC;
- learn what patient and household factors are related to the risk of the infection recurring; and
- study how the bacteria is related to decontamination and decolonization and to the risks of a repeat onset or the spread of infection to others living in the same house.
The projected outcomes and goals include:
- development of the intervention, a study manual, training materials, Internet-based training for clinicians, and ways to make sure the right care is given;
- a protocol for finding patients who need this care and making sure they get the care they need;
- a data system that can be used everywhere via the Internet;
- participation of five community health centers and 278 patients and the completion of 556 home visits; and
- a 50 percent reduction in recurrence of CA-MRSA infection.
Patient and Stakeholder Engagement: Stakeholders include health centers, practicing clinicians and staff, patients, and clinical and laboratory researchers. During monthly meetings, all stakeholders will participate in all phases of the project, including design, implementation, and sharing project results. The PSAC will include one patient participant and one CHW from each CHC, as well as a community-based stakeholder who has collaborated with us since 2012. The PSAC will also meet on its own without the researchers.
Anticipated Impacts: Results will be presented to primary care professionals, infectious disease specialists, public health experts, and community audiences. The greatest potential for replication and scale-up lies in collaboration with the research network, a project to combine health information from over 1 million patients in New York City who get their care at large hospitals, medical centers, and health centers. This work, in turn, will provide the basis for developing and conducting CA-MRSA recurrence and transmission prevention trials across the United States. Our project can also provide information on how to study and treat other bacteria that do not respond to antibiotics.