The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #66014

Melissa Tobin-D'Angelo, MD¹, Kathryn Arnold, MD¹, Susan Lance-Parker, DVM, PhD¹, Mary Ellen Lane, RN, MBA, CCHP², Jennifer Taussig, MPH², and Madie LaMarre, MSN, CFNP³. (1) Georgia Division of Public Health, 2 Peachtree St. NW, Atlanta, GA 30303, 404-657-1105, mtd'angelo@dhr.state.ga.us, (2) Office of Health Services, Georgia Department of Corrections, 2 Martin Luther King Drive, Atlanta, GA 30334, (3) Medical Services, GA Department of Corrections, 2 MLK Dr. SE, Ste. 952, East Tower, Atlanta, GA 30334

While MRSA (methicillin-resistant Staphylococcus aureus) has been a problem in the healthcare setting, MRSA infection also has now emerged in persons with exposure to community settings. Little is known about risk factors in specific community settings, including correctional facilities. In the only published report of an MRSA outbreak in a correctional facility, risk factors included sharing bed linens, touching other inmates’ boils, previous beta-lactam use, and using state-issued soap. A 1500 bed Georgia state prison reported a cluster of MRSA skin infections among inmates in July 2002. Prison healthcare personnel performed case finding through targeted skin disease screening of affected inmates, educated inmates about MRSA and its transmission, and recommended environmental disinfection of inmate living areas. The Georgia Division of Public Health and the Georgia Department of Corrections Office of Health Services collaborated to implement further prevention measures and conduct a case-control study. A case was defined as a skin lesion with pain, redness or discharge with positive culture for MRSA, or such a lesion that was not cultured, but in an inmate who had prior documented MRSA infection. Controls were matched by dorm location. There were 12 cases and 67 controls; all were male. The mean age was 38; 5(6%) were Hispanic, 46(58%) were African-American and 28 (35%) were white. Univariate risk factors were Hispanic ethnicity (OR 10.83, 95% CI 1.20-113.15, p=0.023), taking antibiotics during the past year (OR 4.70, 95% CI 1.09-21.62, p=0.02), picking sores (OR 4, 95% CI .89-18.38, p=0.04), cutting oneself (OR 4.73, 95% CI 0.87-25.8, p=0.047), washing clothes by hand (OR 11.81, 95% CI 1.29-126.31, p=0.02), or sharing soap (OR 24, 95% CI 1.80-695.94, p=0.009). Additional interventions implemented based on these findings included intensified inmate education, increased availability of soap, and improved laundry practices. Facility health care providers standardized skin disease surveillance, wound care, and antimicrobial treatment. Cases decreased in the 3 months following the interventions, but subsequently increased, with 29 cases of MRSA occurring in 26 inmates over the following 3 months. Repeated reinforcement of ongoing inmate and staff education about disease screening, hygiene and appropriate treatment may be necessary to result in an ongoing successful intervention.

Learning Objectives:

2. Participants will recognize the problem of MRSA in correctional facilities.
4. Participants will identify risk factors for MRSA in correctional facilities.
6. Participants will understand barriers to control of MRSA in correctional facilities.

Keywords: Prisoners Health Care, Antibiotic Resistance

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.