Patricia Anne Kritek, MD, EdM

Universal decontamination of intensive care unit patients resulted in fewer bloodstream infections and methicillin-resistant Staphylococcus aureus cultures.

To prevent nosocomial infections, most hospitals routinely screen intensive care unit (ICU) patients for methicillin-resistant Staphylococcus aureus (MRSA) and place carriers in contact precautions. This process is costly for hospitals and isolating for patients. An alternative approach is skin and nares decontamination through chlorhexidine bathing, and intranasal mupirocin. To determine the relative effectiveness of these strategies, investigators conducted an 18-month trial in which 43 hospitals (74,000 patients) were randomized to either MRSA screening with isolation, targeted decontamination (only patients with positive MRSA screens), or universal decontamination (all ICU patients).

Compared with baseline risk, risk during universal decontamination was significantly lower for MRSA-positive clinical cultures (hazard ratio, 0.63) and for bloodstream infections from any pathogen (HR, 0.56). Screening and isolation did not affect risk for these events (HRs, 0.92 and 0.99, respectively). Targeted decontamination results were intermediate (HRs, 0.75 and 0.78, respectively). No strategy significantly lowered risk for MRSA bloodstream infections. Adverse events (skin rash or pruritus in 7 patients in the decontamination groups) were mild and related to chlorhexidine sensitivity.

Citation(s):

Huang SS et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013 Jun 13; 368:2255.