Patient-Centered Comparative Effectiveness Research (CER) Study of Home-based Interventions to Prevent CA-MRSA Infection Recurrence

The overall goal of the project is to develop and evaluate a home-based intervention to
prevent re-infection and transmission of Community-Acquired Methicillin-resistant
Staphylococcus aureus (CA-MRSA) in patients presenting to primary care with skin or soft
tissue infections (SSTIs). Centers for Disease Control (CDC) CA-MRSA guidelines include
incision and drainage, antibiotic sensitivity testing and antibiogram-directed prescribing.
Re-infections are common, ranging from 16% to 43%, and present significant challenges to
clinicians, patients and their families. Several decolonization and decontamination
interventions have been shown to reduce Hospital-Acquired MRSA (HA-MRSA) re-infection and
transmission in intensive care units. Few studies examine the feasibility and effectiveness
of these infection prevention interventions into primary care settings, and none employ
Community Health Workers (CHWs) or "promotoras" to provide home visits for education and
interventions about decolonization and decontamination. This comparative effectiveness
research/patient centered outcomes research builds upon a highly stakeholder-engaged
community-academic research and learning collaborative, including practicing clinicians,
patients, clinical and laboratory researchers, and barbers/beauticians. Clinical Directors
Network (CDN), an established, NIH-recognized best practice Federally Qualified Health
Center (FQHC) Practice-based Research Network (PBRN), and The Rockefeller University propose
to address this question through the completion of four aims: (1) To evaluate the
comparative effectiveness of a CHW/Promotora-delivered home intervention (Experimental
Group) as compared to Usual Care (Control Group) on the primary patient-centered and
clinical outcome (SSTI recurrence rates) and secondary patient-centered and clinical
outcomes (pain, depression, quality of life, care satisfaction) using a two-arm randomized
controlled trial (RCT). (2) To understand the patient-level factors (CA-MRSA infection
prevention knowledge, self-efficacy, decision-making autonomy, prevention
behaviors/adherence) and environmental-level factors (household surface contamination,
household member colonization, transmission to household members) that are associated with
differences in SSTI recurrence rates. (3) To understand interactions of the intervention
with bacterial genotypic and phenotypic variables on decontamination, decolonization, SSTI
recurrence, and household transmission. (4) To explore the evolution of stakeholder
engagement and interactions among patients and other community stakeholders with practicing
community-based clinicians and academic laboratory and clinical investigators over the
duration of the study period.