MRSA Colonization and Control in the Cook County Jail - R01

描述（由申请人提供）：这个为期3年的项目的目标是控制芝加哥库克县监狱社区相关的耐甲氧西林金黄色葡萄球菌（CA-MRSA）的传播。CA-MRSA是一种在健康人群中迅速传播的细菌，已成为该国许多地区的流行病。耐甲氧西林金黄色葡萄球菌引起的感染控制起来既困难又昂贵，因为青霉素和类似药物不能用于治疗。社区中的许多人都无症状地感染了MRSA。在美国的监狱和拘留所中爆发了耐甲氧西林金黄色葡萄球菌感染，在库克县监狱中很常见。我们担心监狱可能成为MRSA快速传播的场所，部分原因是CA-MRSA正在成为芝加哥内城的地方病。我们将研究耐甲氧西林金黄色葡萄球菌在监狱中的传播，以更好地了解细菌是如何在监狱中人与人之间传播的，以及我们如何预防它们的传播。所有被要求参加的被拘留者必须知情同意；他们的隐私将受到严密保护。监狱里的17件物品和表面将首先接受MRSA污染取样。我们将测试3种消毒剂对我们确定的2种最常被污染的表面或物体的消毒效果。此外，将在监狱的某个区域收集18个月内所有皮肤感染细菌的患者的培养物，以确定这些感染是由MRSA引起的，相对于其他细菌的频率。一组2128名最高安全级别的成年在押人员将接受MRSA定植测试，以确定在押人员携带细菌的普遍程度。将在这些被拘留者中进行一项为期6个月的集群随机研究，以确定是否可以使用含氯己定的一次性皮肤清洁布来降低MRSA的传播、定植和感染率。所有MRSA分离株和对甲氧西林敏感的金黄色葡萄球菌分离株的样本，这些样本来自定殖或感染在押人员的标本，以及那些污染监狱表面和物体的标本，将进行基因测试，以确定监狱中存在哪些MRSA菌株。监狱相关菌株将与社区中引起MRSA感染的菌株进行比较。这项研究可能会找到阻止MRSA在监狱和其他地方的健康人群中传播的重要方法。我们希望库克县监狱将成为控制MRSA和其他耐药细菌的模范监狱。

DESCRIPTION (provided by applicant): The goal of this 3-year project is to control the spread of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Chicago's Cook County Jail. CA-MRSA is a bacterium which is spreading rapidly through healthy populations, becoming an epidemic in many regions of the country. MRSA causes infections which are difficult and expensive to control because penicillins and similar drugs cannot be used to treat them. Many people in the community are asymptomatically colonized by MRSA. There have been outbreaks of MRSA infections at prisons and jails in the U.S, and they are common at the Cook County Jail. We fear that jails may be sites of rapid MRSA dissemination, in part because CA-MRSA is becoming endemic to the inner city of Chicago. We will study the spread of MRSA in the jail to better understand how the bacteria are transmitted from person to person there and how we can prevent their transmission. All detainees asked to participate must give informed consent to do so; their privacy will be carefully protected. Seventeen objects and surfaces in the jail will first be sampled for contamination with MRSA. We will test the efficacy of 3 disinfectants to decontaminate the 2 most commonly contaminated surfaces or objects that we identify. In addition, cultures will be collected from all patients with bacterial skin infections for 18 months in a part of the jail in order to determine how frequently these infections are caused by MRSA relative to other bacteria. A group of 2128 maximum-security adult detainees will be tested for colonization with MRSA in order to determine how commonly detainees carry the bacterium. A cluster-randomized 6-month study will be undertaken among these detainees to determine if chlorhexidine-containing disposable cloths for skin cleaning can be used to decrease the rate of MRSA transmission, colonization, and infection. All of the MRSA isolates and a sample of the S. aureus isolates susceptible to methicillin from specimens colonizing or infecting detainees, as well as those contaminating surfaces and objects in the jail will be tested genetically in order to determine which strains of MRSA are present in the jail. The jail-related strains will be compared with strains causing MRSA infection in the community. This study may identify important ways to stop the spread of MRSA among healthy people in jails and prisons, as well as other places. We hope that the Cook County jail will become a model jail for the control of MRSA and other resistant bacteria.