Staphylococcus, not MRSA? A final report of carriage and conversion rates in nursing students.

OBJECTIVE: To evaluate and characterize staphylococcal carriage, possibly including methicillin-resistant Staphylococcus aureus (MRSA), and conversion rates in nursing students across clinical semester rotations and to describe risk factors. DESIGN: A prospective longitudinal cohort design with six times of measurement. Data collected August 2010 to May 2012. Institutional Review Board approval (2010F5693). SETTING: Texas State University, San Marcos, TX. PARTICIPANTS: Eighty-seven nursing students. INTERVENTIONS: A positive MRSA swab was considered an end point for participation. Intervention offered was bactroban (mupirocin) for nasal decolonization and an oral antibiotic, doxycycline; follow-up post treatment collection sample was done to verify decolonization prior to next clinical rotation. MAIN OUTCOME MEASURES: Screening for Staphylococcus aureus and MRSA identification; confirmation and antibiotic susceptibility by Vitek 2; self-administered questionnaires delineating demographics and risk factors; panel logistic regression models by Stata version 13. RESULTS: MRSA colonization did not increase. S. aureus incidence was 17.7 - 26.4%. Staphylococcal species incidence other than S. aureus increased (9.2 - 82.3%). The following odds ratio (OR) associations were found to be statistically significant: boil or skin infections with S. aureus (OR = 2.94, p < .01), working or volunteering in a healthcare facility odds with species other than S. aureus (OR = 4.41, p < .01) and gym and sports facilities odds with S. other (OR 2.45, p < .01). The most frequently occurring species at Wave 5 was S. hominis (21 isolates) while the most frequently occurring species at Wave 6 was S. epidermidis (25 isolates). CONCLUSIONS: MRSA colonization did not increase during longitudinal study. S. aureus colonization remained fairly stable throughout the study (17 - 26%). Species colonization with non S. aureus species (e.g. S. hominis, S. epidermis, S. haemolyticus) increased significantly (9.2 - 82.3%) during clinical rotations. Knowledge of infection control and compliance may have contributed to an absence of MRSA colonization; however, the colonization by other staphylococci has been shown to be a risk factor for MRSA acquisition.

The effect of telephone support groups on costs of care for veterans with dementia.

PURPOSE: Few studies have addressed the effects of caregiver interventions on the costs of care for the care recipient. This study evaluated the effects of a caregiver education and support group delivered via the telephone on care recipient health care utilization and cost. DESIGN AND METHODS: The Telehealth Education Program (TEP) is a manualized program of education and support designed for caregivers of veterans with moderate-to-severe dementia. One hundred fifty-eight spousal caregivers were randomly assigned to either the ten 1-hr sessions of TEP or the usual care (UC). Health care utilization and cost data were extracted from veterans Information System Technology Architecture databases and included outpatient, inpatient, and nursing home data within the VA. RESULTS: Total health care cost data showed a significant (p = .039) average cost savings of $2,768 per patient at 6 months for TEP as compared with UC, but these were not maintained at 1 year. All costs included in the total costs measure contributed to this difference. Inpatient, outpatient, and nursing home costs were all assessed separately, but only nursing home costs reached significance (p = .009), with a savings of $1,057 per patient at 6 months. IMPLICATIONS: The TEP caregiver intervention resulted in short-term cost savings for veteran care recipients. Future studies of caregiver interventions should examine their effects on costs of care for the care recipients in addition to their effects on caregiver outcomes.