Knowledge & Attitudes Regarding Methicillin Resistant Staphylococcus aureus (MRSA) among Caregivers of Hospitalized Children with MRSA

Background:   Increasingly, children are admitted to hospitals either colonized or infected with MRSA.  Caregivers’ knowledge about MRSA and the risks it poses to their children has not been well characterized.    

Objective: To explore the knowledge and attitudes of caregivers regarding MRSA, and to assess the negative consequences of identifying children as MRSA carriers.

Methods: We developed and administered a questionnaire to caregivers of children who were admitted to The Johns Hopkins Hospital from August 2009 to October 2009 and placed in contact isolation for MRSA colonization or infection. Children were identified through hospital surveillance databases and interviews were conducted at the bedside during the hospitalization.

Results: Out of 60 caregivers approached, 57 (95%) consented to participate in the study. 40 (70%) of the caregivers were mothers and 30 (53%) had one or more years of college education. The participants’ children included 17 (30%) who were newly recognized as MRSA colonized or infected during the hospitalization (‘new-MRSA’), and  40 (70%) who had been identified during previous hospitalizations (‘old-MRSA’). 44 (77%) of the caregivers had some knowledge about MRSA; such as knowing that MRSA can spread from person to person (91%), knowing that hand hygiene can prevent the spread of MRSA (93%), and knowing that children can harbor MRSA even without having an infection (77%). Overall 17 (30%) caregivers were unaware that their child was an MRSA carrier despite their child being in contact isolation; 10 whose children had ‘old-MRSA’ (59%) and 7 whose children had ‘new-MRSA’ (41%). Of caregivers who knew their child had MRSA, 88% had concerns; 53% felt that their child was treated differently due to their having MRSA; 73% worried about the risk of future MRSA infection in their child; 35% worried about their child spreading MRSA to others. Common concerns that originated from open-ended questions include long term risk of infection from harboring MRSA, social stigma from being an MRSA carrier and the impact of this stigma on the child, and insufficient knowledge on how to protect the child and others who are vulnerable at home.   Other open-ended questions revealed that most caregivers were eager to know more about MRSA, particularly if it can be eradicated; some in hope that eradication would reduce the risk of infection and remove the stigma of being an MRSA carrier.  

Conclusions: Caregivers of children hospitalized with MRSA infection or colonization are frequently unaware that their child has MRSA.  Our data suggest that caregivers are concerned about the real and perceived risks that MRSA poses to their children and are eager for more information.  Future studies characterizing the tangible (infection) and intangible (stigma) consequences of MRSA in hospitalized children are needed, so that physicians can better inform and counsel caregivers.