Results Summary

What was the research about?

Staphylococcus aureus, or staph, is a type of bacteria found on people’s skin. MRSA and MSSA are types of staph infections that are hard to treat. They can lead to serious infections or even death. These infections can come back or spread to other people.

In this study, the research team compared two ways to help patients keep MRSA and MSSA infections from coming back. In both, doctors tested the infection for staph at a health center or emergency room, or ER, and treated it. Doctors gave patients antibiotics to take at home.

All patients also had a home visit from a community health worker specially trained to teach people about getting rid of staph. In the first way, the community health worker shared a pamphlet about living with MRSA. In the second way, the community health worker shared the pamphlet and gave instructions and materials for a five-day home hygiene plan for the patient and other willing household members. The plan included

  • Using antibiotic cream in the nose
  • Bathing with a strong soap that kills most bacteria
  • Wiping down home surfaces with bleach
  • Instructions for doing laundry and washing hands

The research team looked at whether the skin infections came back and patients’ pain levels, symptoms of depression, satisfaction with social activities, and satisfaction with care.

What were the results?

After six months, the rate of infections that came back didn’t differ between patients who received the home hygiene plan and those who didn’t. Overall, skin infections came back in about 11 percent of patients.

Patients who received the home hygiene plan and those who didn’t reported similar

  • Pain levels
  • Symptoms of depression
  • Satisfaction with social activities
  • Satisfaction with care

Who was in the study?

This study included 119 patients with MRSA or MSSA infections. Patients received care at one of three health centers or three ERs in New York City. Of the patients, 24 percent were black, 10 percent were white, and 6 percent were more than one race or ethnicity or didn’t report it; also, 60 percent were Hispanic. The average age was 38, and 61 percent were men.

What did the research team do?

The research team assigned patients by chance to receive the home visit with or without the home hygiene plan.

To see if infections came back within six months, the research team looked at patients’ health records. At the start of the study and again one and six months later, patients reported by phone about their pain, depression, satisfaction with activities, and satisfaction with care.

Primary care clinicians, scientists, community health workers, patients, and community members were involved in all parts of the study.

What were the limits of the study?

The hygiene plan lasted five days, which may be too short to keep skin infections from coming back. Results may have been different if the hygiene plan was longer or was repeated to keep the original bacteria from coming back or new bacteria from coming into the home.

Future research could look at whether repeating the home hygiene plan or making it longer keeps these infections from coming back.

How can people use the results?

Health centers and ERs can use these results when considering ways to help patients keep MRSA and MSSA infections from coming back.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers asked for greater clarity on when participants were randomly assigned to the intervention versus control groups because in some places the report indicated that group allocation occurred prior to the baseline home visit. The researchers explained that the study’s statistician randomized assignments upon confirming each patient’s eligibility, and study staff and participants found out patients’ study group assignments at the baseline home visit after the baseline measures had been collected.
  • The reviewers then noted that out of the 186 individuals randomized to the intervention versus control groups before the baseline home visit, 120 completed the baseline visit. The reviewers recommended that the researchers conduct intent-to-treat analyses that included all 186 individuals, rather than only analyses on the 120 who completed baseline visits. The researchers added these analyses and presented a more in-depth series of tables and figures based on this reanalysis, which they said revealed no difference in treatment effect. At the reviewers’ recommendation, the researchers also added a comment about the large drop-out number in describing their study limitations.
  • The reviewers questioned the approaches taken to address missing data and asked the researchers to clarify their strategies and to include their sensitivity analyses in the report. The researchers revised the report to explain that they came to a belief that the missing data in their study were missing at random because there were no external occurrences that could have affected which data were missing and when. In addition, their sensitivity analyses tested whether the results for skin and soft tissue recurrence changed if the missing values were all set to yes or all set to no. The researchers presented these results, which demonstrated no significant changes in the results based on these analyses.

Conflict of Interest Disclosures

Project Information

Jonathan N. Tobin, PhD
Clinical Directors Network, Inc.
Patient-Centered CER of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence

Key Dates

September 2014
October 2019

Study Registration Information


Has Results
Award Type
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: January 25, 2023