Universal approach to MRSA-prevention in ICU is most effective

By Sarah Guy, medwireNews Reporter

Universal decolonization of all patients admitted to intensive care units (ICUs) using chlorhexidine baths and mupirocin treatment for 5 days significantly reduces the risk for infection with methicillin-resistant Staphylococcus aureus (MRSA), report researchers.

The approach was pitted against two other strategies; either screening patients for MRSA on admission to the ICU followed by isolation if positive (screening and isolation), or screening patients followed by isolation and decolonization with the chlorhexidine and mupirocin regimen if positive (targeted decolonization).

Indeed, the rate of bloodstream infections from all pathogens was significantly reduced at ICU's assigned to the universal decolonization strategy, the researchers reported at Infectious Diseases Week 2012 in San Diego, California, USA.

"This trial provides strong evidence that removing bacteria from the skin and nose is highly effective at preventing serious infection in high-risk ICU patients," remarked co-author Susan Huang (University of California) in a press statement.

She added that the universal decolonization approach may make screening for drug-resistant organisms unnecessary.

ICUs at 43 hospitals in 16 US states were randomly assigned to either screening and isolation, targeted decolonization, or universal decolonization, and MRSA rates were compared between a 1-year preintervention baseline period (n=48,390 ICU admissions) and an 18-month intervention period (n=74,256 ICU admissions).

Implementing universal decolonization resulted in a significant 37% reduction in the risk for MRSA compared with baseline, while neither screening and isolation nor targeted decolonization resulted in such a reduction, say Huang and colleagues.

Furthermore, the risk for bloodstream infections due to all pathogens was reduced by a significant 44% at institutions assigned to universal decolonization, but not at institutions employing the other strategies.

Adjustment of data for age, gender, race, payer (ie, insurance vs private), comorbidities, and MRSA history did not alter the significance of the findings, notes the research team.

"I am pleased to say that on the basis of this study, Hospital Corporation of America [a large private operator of healthcare facilities in the USA and UK] has adopted the universal strategy for treating patients in ICU at their 160 facilities," said Huang in the media release.

The researchers are planning further research in the area to determine the potential cost benefit of chlorhexidine and mupirocin administration in comparison with screening for bloodstream infections.

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