title: Nonimpact of Decolonization as an Adjunctive Measure to Contact Precautions for the Control of Methicillin-Resistant Staphylococcus aureus Transmission in Acute Care.
abstract: This was an observational study comparing methicillin-resistant Staphylococcus aureus (MRSA) transmission with no decolonization of medical patients to required decolonization of all MRSA carriers during two consecutive periods: baseline with no decolonization of medical patients (16 months) and universal MRSA carrier decolonization (13 months). The setting was a one-hospital, 156-bed facility with 9,200 annual admissions. Regression models were used to compare rates of MRSA acquisition. The chi-square test was used to compare event frequencies. We used rates of MRSA clinical disease as an outcome monitor of the program. Analysis was done on 15,666 patients who had admission and discharge tests; 27.9% of inpatient days were occupied by a MRSA-positive patient (colonized patient-days) who received decolonization while hospitalized during the baseline period (this 27.9% represented those who had planned surgery) compared to 76.0% during the intervention period (P < 0.0001). The rate of MRSA transmission was 97 events (1.0%) for 9,415 admissions (2.0 transmission events/1,000 patient-days) during baseline and was 87 (1.4%) for 6,251 admissions (2.7 transmission events/1,000 patient-days) during intervention (P = 0.06; rate ratio, 0.74; 95% confidence interval [CI], 0.55 to 1.00). The MRSA nosocomial clinical disease rate was 5.9 infections/10,000 patient-days in the baseline period and was 7.2 infections/10,000 patient-days for the intervention period (rate ratio, 0.82; 95% CI, 0.46 to 1.45; P = 0.49). Decolonization of MRSA patients does not add benefit when contact precautions are used for patients colonized with MRSA in acute (hospital) care.
authors.affiliation: University of Chicago Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA Department of Medicine, University of Chicago Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA Department of Pathology, University of Chicago Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA Department of Medicine, Division of Infectious Diseases, NorthShore University HealthSystem, Evanston, Illinois, USA Department of Pathology and Laboratory Medicine, Division of Microbiology, NorthShore University HealthSystem, Evanston, Illinois, USA Department of Infection Control, NorthShore University HealthSystem, Evanston, Illinois, USA lance1@uchicago.edu arobicsek@northshore.org.
authors.forename: Lance R
authors.initials: LR
authors.lastname: Peterson
authors.affiliation: Department of Infection Control, NorthShore University HealthSystem, Evanston, Illinois, USA.
authors.forename: Marc O
authors.initials: MO
authors.lastname: Wright
authors.affiliation: Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Beaumont
authors.affiliation: Department of Infection Control, NorthShore University HealthSystem, Evanston, Illinois, USA.
authors.forename: Vanida
authors.initials: V
authors.lastname: Komutanon
authors.affiliation: Department of Pathology and Laboratory Medicine, Division of Microbiology, NorthShore University HealthSystem, Evanston, Illinois, USA.
authors.forename: Parul A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: Department of Pathology and Laboratory Medicine, Division of Microbiology, NorthShore University HealthSystem, Evanston, Illinois, USA.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Schora
authors.affiliation: Department of Pathology and Laboratory Medicine, Division of Microbiology, NorthShore University HealthSystem, Evanston, Illinois, USA.
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Schmitt
authors.affiliation: University of Chicago Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA Department of Medicine, University of Chicago Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA Department of Medicine, Division of Infectious Diseases, NorthShore University HealthSystem, Evanston, Illinois, USA Department of Infection Control, NorthShore University HealthSystem, Evanston, Illinois, USA lance1@uchicago.edu arobicsek@northshore.org.
authors.forename: Ari
authors.initials: A
authors.lastname: Robicsek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002353:Carrier State; D002710:Chlorhexidine / Q000627:therapeutic use*; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development; D008875:Middle Aged; D016712:Mupirocin / Q000627:therapeutic use*; D010343:Patient Admission; D012044:Regression Analysis; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D002710:Chlorhexidine