title: An observational study of the universal use of octenidine to decrease nosocomial bloodstream infections and MDR organisms.
abstract: To investigate the effect of universal decolonization with octenidine on the incidence of ICU-acquired bloodstream infections (BSI) and MDR organisms (MDRO).
  
  
  
  A system-wide change in practice was performed in the ICUs of a university hospital with three campuses (eight medical ICUs and nine surgical ICUs). All ICUs had a general admission screening strategy for MRSA with subsequent isolation in the 12 month baseline period, which was stopped. After a wash-in period of 1 month, decolonization of the nose with octenidine nasal gel and octenidine wash cloths was introduced. The endpoints were ICU-acquired BSI and ICU-acquired MDRO isolates from clinical cultures. Segmented regression analysis of interrupted time series was used to assess the effect of intervention.
  
  
  
  A total of 29 532 ICU patients (16 677 surgical and 12 855 medical) were included in the study. The baseline incidence density of ICU-acquired BSI was 5.1 per 1000 patient days and the baseline ICU-acquired MRSA rate was 0.97 per 1000 patient days. Whereas no significant effect on either outcome was found in surgical ICUs, we identified a significant effect on ICU-acquired BSI for the intervention in medical ICUs by means of multivariate analysis (incidence rate ratio 0.78; 95% CI 0.65-0.94). In addition, the intervention was also effective in decreasing ICU-acquired MRSA in medical ICUs (incidence rate ratio 0.58; 95% CI 0.41-0.82). No effect on ICU-acquired VRE and Gram-negative MDRO was found.
  
  
  
  System change was successful by decreasing infection rates in medical ICUs and improving the management in all ICUs.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Hindenburgdamm 27, 12203 Berlin, Germany petra.gastmeier@charite.de.
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Kämpf
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Behnke
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Geffers
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Hindenburgdamm 27, 12203 Berlin, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002353:Carrier State / Q000188:drug therapy*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D007097:Imines; D007362:Intensive Care Units; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*; D018805:Sepsis / Q000453:epidemiology / Q000517:prevention & control*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000891:Anti-Infective Agents, Local; D007097:Imines; D011725:Pyridines; C034213:octenidine