Intranasal octenidine for methicillin-resistant Staphylococcus aureus (MRSA) carriers and universal octenidine bathing reduced MRSA acquisition in an acute-care general ward

Abstract

In this quasi-experimental before-and-after study in a methicillin-resistant staphylococcus aureus (MRSA) high-prevalence acute-care dermatology ward from August 2016 to November 2018, patients admitted during intervention period who received additional topical intranasal octenidine were 63% less likely to acquire MRSA than those receiving universal daily octenidine bathing alone during baseline period (aOR, 0.37; 95% CI, 0.14–0.98).

Clinical Evidence for the Use of Octenidine Dihydrochloride to Prevent Healthcare-Associated Infections and Decrease Staphylococcus aureus Carriage or Transmission—A Review

“…Against this background, OCT nasal gel could be an alternative for decolonizing S. aureus carriage in the nares. While several studies identified in this review used OCT nasal gel as a part of their interventions [19,20,22,24,28,30,41,46], we identified only one prospective study that directly compared the effectiveness of mupirocin, OCT, and chlorhexidine/neomycin nasal ointments for eradicating S. aureus [19]. This study clearly showed that OCT 0.1% was the least effective agent.…”

“…Of the remaining seven studies that compared the effects of OCT use to either other antiseptics or no antiseptic use, three evaluated the effects of nasal OCT (the results for this secondary outcome are summarized below) [19,20,22]. In the other four studies, one reported no reduction in nosocomial MRSA acquisitions (p = 0.31) and MRSA clinical infections (p = 0.96) in a setting where patients received OCT body washes pending the results of an MRSA admission screening (baseline phase).…”

“…Intranasal application of OCT was performed in ten of the included studies measuring different primary outcomes [19,20,[22][23][24]28,30,40,41,46]. How often the nasal gel was applied daily was unspecified in five studies, while it was used thrice daily in three, twice daily in one, and once daily in one study (Table S4).…”

“…Aung et al routinely performed OCT whole-body washes for all patients in a dermatology ward [20]. After starting to additionally treat MRSA carriers among these patients with OCT nasal gel for five days, the nosocomial MRSA acquisition rate in the ward decreased (p = 0.046) and the number of MRSA carriers who were screened negative at discharge increased (from 6/92 (9.7%) in the baseline period to 10/47 (21.3%) in the nasal treatment period) [20].…”

SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update

“… 236 Also in Singapore, a study involving MRSA prevention in a high-prevalence acute-care dermatology ward, patients admitted during intervention period who received additional topical intranasal octenidine were 63% less likely to acquire MRSA than those receiving universal daily octenidine bathing alone during baseline period. 237 Denkel et al 238 performed a randomized controlled trial that compared CHG and octenidine with routine care on the prevention of central-line–associated bloodstream infections in 72 ICUs in Germany. Compared to routine bathing, neither showed significant preventive effect on CLABSI rates, although the authors stated that the study risked being underpowered; CLABSI rates in routine care group were lower than initially assumed.…”