title: Beyond the Intensive Care Unit (ICU): Countywide Impact of Universal ICU Staphylococcus aureus Decolonization.
abstract: A recent trial showed that universal decolonization in adult intensive care units (ICUs) resulted in greater reductions in all bloodstream infections and clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) than either targeted decolonization or screening and isolation. Since regional health-care facilities are highly interconnected through patient-sharing, focusing on individual ICUs may miss the broader impact of decolonization. Using our Regional Healthcare Ecosystem Analyst simulation model of all health-care facilities in Orange County, California, we evaluated the impact of chlorhexidine baths and mupirocin on all ICU admissions when universal decolonization was implemented for 25%, 50%, 75%, and 100% of ICU beds countywide (compared with screening and contact precautions). Direct benefits were substantial in ICUs implementing decolonization (a median 60% relative reduction in MRSA prevalence). When 100% of countywide ICU beds were decolonized, there were spillover effects in general wards, long-term acute-care facilities, and nursing homes resulting in median 8.0%, 3.0%, and 1.9% relative MRSA reductions at 1 year, respectively. MRSA prevalence decreased by a relative 3.2% countywide, with similar effects for methicillin-susceptible S. aureus. We showed that a large proportion of decolonization's benefits are missed when accounting only for ICU impact. Approximately 70% of the countywide cases of MRSA carriage averted after 1 year of universal ICU decolonization were outside the ICU.
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Bartsch
authors.forename: Kim F
authors.initials: KF
authors.lastname: Wong
authors.forename: James A
authors.initials: JA
authors.lastname: McKinnell
authors.forename: Eric
authors.initials: E
authors.lastname: Cui
authors.forename: Chenghua
authors.initials: C
authors.lastname: Cao
authors.forename: Diane S
authors.initials: DS
authors.lastname: Kim
authors.forename: Loren G
authors.initials: LG
authors.lastname: Miller
authors.forename: Susan S
authors.initials: SS
authors.lastname: Huang
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001513:Beds / Q000382:microbiology; D002140:California / Q000453:epidemiology; D002710:Chlorhexidine / Q000627:therapeutic use; D003198:Computer Simulation; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D004203:Disinfection / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000706:statistics & numerical data*; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus / Q000254:growth & development* / Q000276:immunology; D016712:Mupirocin / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission
chemical_list: D000890:Anti-Infective Agents; D016712:Mupirocin; D002710:Chlorhexidine
keywords: MRSA; MSSA; decolonization; hospitals; intensive care unit; nursing homes