Thirteen hospitals under Nashville, Tenn.-based Hospital Corporation of America reduced the rate of methicillin-resistant Staphylococcus aureus by implementing universal decolonization in the intensive care unit, according to a study in New England Journal of Medicine.
Researchers compared three strategies for reducing MRSA by randomly assigning 43 HCA hospitals to one of the following protocols:
1. Screening and isolation (16 hospitals): Patients were screened for MRSA upon ICU admission, and contact precautions were implemented for patients with a history of MRSA colonization or infection and for those who had any positive MRSA test. All hospitals followed this standard of care before the study.
2. Targeted decolonization (14 hospitals): MRSA screening and contact precautions were similar to those in the first strategy. In addition, patients known to have MRSA colonization or infection underwent a five-day decolonization regimen that included twice-daily intranasal mupirocin and daily bathing with chlorhexidine-impregnated cloths.
3. Universal decolonization (13 hospitals): No patients were screened for MRSA on admission to the ICU, but contact precautions were similar to those in strategy one. All patients received twice-daily intranasal mupirocin for five days and daily bathing with chlorhexidine-impregnated cloths for the entire ICU stay.
Researchers analyzed the percent change in ICU-attributable MRSA-positive clinical cultures from a 12-month baseline period in 2009 to an 18-month intervention period from 2010 through 2011.
The third strategy — universal decolonization — was the most effective strategy in reducing MRSA-positive clinical cultures with a 37 percent reduction. This strategy also prevented one bloodstream infection per 54 patients who underwent decolonization, resulting in a 44 percent total decrease in bloodstream infections from any pathogen.
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Researchers compared three strategies for reducing MRSA by randomly assigning 43 HCA hospitals to one of the following protocols:
1. Screening and isolation (16 hospitals): Patients were screened for MRSA upon ICU admission, and contact precautions were implemented for patients with a history of MRSA colonization or infection and for those who had any positive MRSA test. All hospitals followed this standard of care before the study.
2. Targeted decolonization (14 hospitals): MRSA screening and contact precautions were similar to those in the first strategy. In addition, patients known to have MRSA colonization or infection underwent a five-day decolonization regimen that included twice-daily intranasal mupirocin and daily bathing with chlorhexidine-impregnated cloths.
3. Universal decolonization (13 hospitals): No patients were screened for MRSA on admission to the ICU, but contact precautions were similar to those in strategy one. All patients received twice-daily intranasal mupirocin for five days and daily bathing with chlorhexidine-impregnated cloths for the entire ICU stay.
Researchers analyzed the percent change in ICU-attributable MRSA-positive clinical cultures from a 12-month baseline period in 2009 to an 18-month intervention period from 2010 through 2011.
The third strategy — universal decolonization — was the most effective strategy in reducing MRSA-positive clinical cultures with a 37 percent reduction. This strategy also prevented one bloodstream infection per 54 patients who underwent decolonization, resulting in a 44 percent total decrease in bloodstream infections from any pathogen.
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