title: Decrease in Staphylococcus aureus colonization and hospital-acquired infection in a medical intensive care unit after institution of an active surveillance and decolonization program.
abstract: OBJECTIVE
  To evaluate the effects of an active surveillance program for Staphylococcus aureus linked to a decolonization protocol on the incidence of healthcare-associated infection and new nasal colonization due to S. aureus.
  
  
  METHODS
  Retrospective quasi-experimental study.
  
  
  METHODS
  An 18-bed medical intensive care unit at a tertiary care center in Cleveland, Ohio.
  
  
  METHODS
  From January 1, 2006, through December 31, 2007, all patients in the medical intensive care unit were screened for S. aureus nasal carriage at admission and weekly thereafter. During the preintervention period, January 1 through September 30, 2006, only surveillance occurred. During the intervention period, January 1 through December 31, 2007, S. aureus carriers received mupirocin intranasally. Beginning in February 2007, carriers also received chlorhexidine gluconate baths.
  
  
  RESULTS
  During the preintervention period, 604 (73.7%) of 819 patients were screened for S. aureus nasal carriage, yielding 248 prevalent carriers (30.3%). During the intervention period, 752 (78.3%) of 960 patients were screened, yielding 276 carriers (28.8%). The incidence of S. aureus carriage decreased from 25 cases in 3,982 patient-days (6.28 cases per 1,000 patient-days) before intervention to 18 cases in 5,415 patient-days (3.32 cases per 1,000 patient-days) (P=.04; relative risk [RR], 0.53 [95% confidence interval {CI}, 0.28-0.97]) and from 9.57 to 4.77 cases per 1,000 at-risk patient-days (P=.02; RR, 0.50 [95% CI, 0.27-0.91]). The incidence of S. aureus hospital-acquired bloodstream infection during the 2 periods was 2.01 and 1.11 cases per 1,000 patient-days, respectively (P=.28). The incidence of S. aureus ventilator-associated pneumonia decreased from 1.51 to 0.18 cases per 1,000 patient-days (P=.03; RR, 0.12 [95% CI, 0.01-0.83]). The total incidence of S. aureus hospital-acquired infection decreased from 3.52 to 1.29 cases per 1,000 patient-days (P=.03; RR, 0.37 [95% CI, 0.14-0.90]).
  
  
  CONCLUSIONS
  Active surveillance for S. aureus nasal carriage combined with decolonization was associated with a decreased incidence of S. aureus colonization and hospital-acquired infection.
authors.affiliation: Medicine Institute, Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. frasert@ccf.org
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Fraser
authors.forename: Cynthia
authors.initials: C
authors.lastname: Fatica
authors.forename: Michele
authors.initials: M
authors.lastname: Scarpelli
authors.forename: Alejandro C
authors.initials: AC
authors.lastname: Arroliga
authors.forename: Jorge
authors.initials: J
authors.lastname: Guzman
authors.forename: Nabin K
authors.initials: NK
authors.lastname: Shrestha
authors.forename: Eric
authors.initials: E
authors.lastname: Hixson
authors.forename: Miriam
authors.initials: M
authors.lastname: Rosenblatt
authors.forename: Steven M
authors.initials: SM
authors.lastname: Gordon
authors.forename: Gary W
authors.initials: GW
authors.lastname: Procop
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008712:Methicillin / Q000494:pharmacology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D016712:Mupirocin / Q000494:pharmacology; D009296:Nasal Cavity / Q000382:microbiology; D009820:Ohio / Q000453:epidemiology; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000382:microbiology; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D016712:Mupirocin; D008712:Methicillin