title: Significant reduction in methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia associated with the institution of a prevention protocol.
abstract: OBJECTIVE
  To determine whether the institution of a methicillin-resistant Staphylococcus aureus prevention protocol was associated with a decrease in methicillin-resistant S. aureus ventilator-associated pneumonia in long-term, acute care ventilator patients.
  
  
  METHODS
  A retrospective chart review comparing the number of episodes of clinical pneumonia per patient ventilator day in the 12 months preceding and 24 months following the introduction of the protocol.
  
  
  METHODS
  University affiliated, long-term, acute care ventilator hospital.
  
  
  METHODS
  Long-term, acute care ventilated patients who presented with clinical pneumonia.
  
  
  METHODS
  Addition of a methicillin-resistant S. aureus prevention protocol. In addition to universal precautions, the protocol consisted of mupirocin 2% ointment applied to the anterior nares, and whole body washing with chlorhexidine. All patients were given mupirocin and chlorhexidine twice weekly. Patients were cohorted in the same room if they were, or had been, infected or colonized with methicillin-resistant S. aureus in any anatomical location or at any time. This procedure replaced strict isolation of methicillin-resistant S. aureus-infected or colonized individuals.
  
  
  RESULTS
  Clinical pneumonia was diagnosed when a patient developed fever, bronchorrhea, increased white blood cell count, methicillin-resistant S. aureus isolated from the tracheal aspirate, and new or increasing infiltrate on chest roentgenograph. During the 12 months preceding the protocol, there were 0.2% episodes of methicillin-resistant S. aureus ventilator-associated pneumonia per ventilated patient day compared with 0.026% in the 24 months after the protocol (p < .001). The relative and absolute risk reductions associated with the introduction of the protocol were 87% and 6, respectively.
  
  
  CONCLUSIONS
  The period following the institution of the protocol showed a significant reduction in episodes of clinical pneumonia compared with the 12-month period preceding the use of the protocol (p < .001). Thus, we conclude that the introduction of this protocol is associated with a significant decrease in methicillin-resistant S. aureus ventilator-associated pneumonia.
authors.affiliation: Division of Pulmonary, Critical Care and Occupational Medicine, Vencor-Tampa Hospital, FL, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Rumbak
authors.forename: M R
authors.initials: MR
authors.lastname: Cancio
mesh_terms: D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D017053:Infection Control; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011023:Pneumonia, Staphylococcal / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015995:Prevalence; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000187:drug effects*; D012122:Ventilators, Mechanical / Q000009:adverse effects*