Randomized comparison of 2 protocols to prevent acquisition of methicillin-resistant Staphylococcus aureus: results of a 2-center study involving 500 patients.
OBJECTIVE
To compare an interventional protocol with a standard protocol for preventing the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU).


METHODS
Prospective, randomized, controlled, parallel-group, nonblinded clinical trial.


METHODS
Medical ICUs of 2 French university hospitals.


METHODS
Five hundred adults with an expected length of stay in the ICU greater than 48 hours.


METHODS
For the intervention group, the protocol required repeated MRSA screening, contact and droplet isolation precautions for patients at risk for MRSA at ICU admission and for MRSA-positive patients, and decontamination with nasal mupirocin and chlorhexidine body wash for MRSA-positive patients. For the standard group, the standard precautions protocol was used, and the results of repeated MRSA screening in the standard group were not communicated to investigators.


METHODS
MRSA acquisition rate in the ICU. An audit was conducted to assess compliance with hygiene and isolation precautions.


RESULTS
In the intent-to-treat analysis ([Formula: see text]), the MRSA acquisition rate in the ICU was similar in the standard (13 [5.3%] of 243) and intervention (16 [6.5%] of 245) groups ([Formula: see text]). The audit showed that the overall compliance rate was 85.5% in the standard group and 84.1% in the intervention group ([Formula: see text]), although compliance was higher when isolation precautions were absent than when they were in place (88.2% vs 79.1%; [Formula: see text]). MRSA incidence rates were higher without isolation precautions (7.57‰) than with isolation precautions (2.36‰; [Formula: see text]).


CONCLUSIONS
Individual allocation to MRSA screening, isolation precautions, and decontamination do not provide individual benefit in reducing MRSA acquisition, compared with standard precautions, although the collective risk was lower during the periods of isolation.


BACKGROUND
Clinicaltrials.gov identifier: NCT00151606.
Medical Intensive Care Department, Pontchaillou Hospital, Rennes 1 University, Rennes, France. christophe.camus@chu-rennes.fr
Christophe
C
Camus
Eric
E
Bellissant
Annick
A
Legras
Alain
A
Renault
Arnaud
A
Gacouin
Sylvain
S
Lavoué
Bernard
B
Branger
Pierre-Yves
PY
Donnio
Pascal
P
le Corre
Yves
Y
Le Tulzo
Dominique
D
Perrotin
Rémi
R
Thomas
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D002710:Chlorhexidine / Q000008:administration & dosage; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D005602:France; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D016712:Mupirocin / Q000627:therapeutic use; D009666:Nose / Q000382:microbiology; D010356:Patient Isolation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D002710:Chlorhexidine