The Effect of Universal Decolonization With Screening in Critical Care to Reduce MRSA Across an Entire Hospital

Abstract

OBJECTIVE To describe the effect of universal methicillin-resistant Staphylococcus aureus (MRSA) decolonization therapy in a large intensive care unit (ICU) on the rates of MRSA cases and acquisitions in a UK hospital. DESIGN Descriptive study. SETTING University Hospitals Birmingham (UHB) NHS Foundation Trust is a tertiary referral teaching hospital in Birmingham, United Kingdom, that provides clinical services to nearly 1 million patients every year. METHODS A break-point time series analysis and kernel regression models were used to detect significant changes in the cumulative monthly numbers of MRSA bacteremia cases and acquisitions from April 2013 to August 2016 across the UHB system. RESULTS Prior to 2014, all ICU patients at UHB received universal MRSA decolonization therapy. In August 2014, UHB discontinued the use of universal decolonization due to published reports in the United Kingdom detailing the limited usefulness and cost-effectiveness of such an intervention. Break-point time series analysis of MRSA acquisition and bacteremia data indicated that break points were associated with the discontinuation and subsequent reintroduction of universal decolonization. Kernel regression models indicated a significant increase (P<.001) in MRSA acquisitions and bacteremia cases across UHB during the period without universal decolonization. CONCLUSION We suggest that routine decolonization for MRSA in a large ICU setting is an effective strategy to reduce the spread and incidence of MRSA across the whole hospital. Infect Control Hosp Epidemiol 2017;38:430-435.

Wiping out MRSA: effect of introducing a universal disinfection wipe in a large UK teaching hospital

“…In response to the National One Week Prevalence Audit of MRSA, QEHB implemented a revised strategy for the control of MRSA [20]. Before 2014 all ICU patients at QEHB received universal MRSA decolonization therapy regardless of their MRSA status [8]. In August 2014 QEHB discontinued the use of universal decolonization in the ICU and stopped MRSA screening to low-risk patients such as day cases having minor procedures such as endoscopy [8].…”

“…Queen Elizabeth Hospital Birmingham (QEHB), part of University Hospitals Birmingham (UHB) NHS Foundation Trust is a tertiary referral teaching hospital in Birmingham, UK that provides clinical services to nearly one million patients every year [8].…”

“…As described previously by Bradley et al, (2017) before August 2014 all ICU patients at UHB received universal MRSA decolonization therapy regardless of their MRSA status [8]. Between August 2014-December 2015 universal decolonization therapy of all ICU patients was withdrawn and only MRSA positive patients received MRSA decolonization therapy [8]. In December 2015 UHB reintroduced universal MRSA decolonization therapy to all ICU patients regardless of their MRSA status [8].…”

“…Between August 2014-December 2015 universal decolonization therapy of all ICU patients was withdrawn and only MRSA positive patients received MRSA decolonization therapy [8]. In December 2015 UHB reintroduced universal MRSA decolonization therapy to all ICU patients regardless of their MRSA status [8].…”

“…It results in increased length of hospital stay, risk of death and treatment costs [4], with colonized and infected patients acting as reservoirs for the spread of MRSA within hospitals [5, 6]. Isolation and decolonization are the two main targeted control measures for reducing transmission of MRSA within hospitals [7, 8].…”