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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

'Universal decolonization' study reinvigorates debate on active screening for MRSA

As originally described in the November 2012 issue of Hospital Infection Control & and Prevention, researchers have demonstrated in a large-scale trial that a combination of daily chlorhexidine baths and a five-day regimen of nasal mupirocin reduced bloodstream infections (BSIs) for all pathogens by an impressive 44%.

Though it began primarily as an intervention against methicillin-resistant Staphylococcus aureus (MRSA), the decolonization approach proved effective against a wide array of pathogens. Overall, universal decolonization with chlorhexidine and mupirocin in adult ICUs yielded a 37% reduction in risk of an MRSA clinical isolate and a 44% reduction in risk of bloodstream infections due to all pathogens. Bloodstream infections due to all causes in the universal decolonization group decreased from 6.1 infections per 1,000 patient days to 3.6 infections.

Recent publication of the study in the New England Journal of Medicine prompted a flurry of reactions and reinvigorated the standing debate on whether active surveillance cultures are preferable to the universal decolonization protocol described in the study.

“The results highlight that the widespread practice of active detection and isolation may not be the best answer to reducing the transmission of MRSA,” says Daniel Diekema, MD, president-elect of the Society for Healthcare Epidemiology of America (SHEA). “The healthcare field must continue to look to rigorous, evidence-based research like this when considering infection prevention strategies.”

The findings could also reduce healthcare costs since a common state-mandated method of screening and isolation to fight MRSA in the ICU was shown to fall short in protecting patients, he added.

“Reducing the burden of healthcare-associated infection is essential, but our approaches and guidance must be grounded in research, rather than mandated by legislative action,” Diekema says.

However, in a statement released by the MRSA Survivors Network, a health care epidemiologist said the active detection and isolation approach he is currently using against MRSA is yielding better results than the decolonization protocol described in the study .

“We continue to believe that doing the best intervention for each particular infection control problem is more effective and less costly than trying to do the single same intervention for every problem,” says Lance Peterson, MD, director of microbiology and infectious diseases research at NorthShore University HealthSystem in Evanston, IL.

Looking at his last 38 months of ICU infection data – which includes 55,350 patients in ICUs of the four-hospital system – Peterson says using active screening and patient isolation produced much greater reductions in MRSA and all-cause BSIs than the protocol used in the study.

Illinois is one of nine states that currently require some version of active screening and isolation for MRSA patients.