Active Surveillance, Decolonization Associated With Decreased HAIs

Fraser TG, et al. (2010) note a relationship between colonization and bacteremia, so they sought to evaluate the effects of an active surveillance program for Staphylococcus aureus linked to a decolonization protocol on the incidence of healthcare-associated infection (HAI) and new nasal colonization due to S. aureus.

In a retrospective quasi-experimental study conducted from Jan. 1, 2006 through Dec. 31, 2007in an 18-bed medical intensive care unit (ICU) at the Cleveland Clinic, the researchers screened all patients for S. aureus nasal carriage at admission and weekly thereafter. The researchers add that during the pre-intervention period, Jan. 1 through Sept. 30, 2006, only surveillance occurred. During the intervention period, Jan. 1 through Dec. 31, 2007, S. aureus carriers received mupirocin intranasally; beginning in February 2007, carriers also received chlorhexidine gluconate baths.

Fraser TG, et al. (2010) report that during the pre-intervention period, 604 (73.7 percent) of 819 patients were screened for S. aureus nasal carriage, yielding 248 prevalent carriers (30.3 percent). During the intervention period, 752 (78.3 percent) of 960 patients were screened, yielding 276 carriers (28.8 percent). The incidence of S. aureus carriage decreased from 25 cases in 3,982 patient-days (6.28 cases per 1,000 patient-days) before intervention to 18 cases in 5,415 patient-days (3.32 cases per 1,000 patient-days) and from 9.57 to 4.77 cases per 1,000 at-risk patient-days.

The researchers report that the incidence of S. aureus hospital-acquired bloodstream infection during the two periods was 2.01 and 1.11 cases per 1,000 patient-days, respectively. The incidence of S. aureus ventilator-associated pneumonia decreased from 1.51 to 0.18 cases per 1,000 patient-days. The total incidence of S. aureus hospital-acquired infection decreased from 3.52 to 1.29 cases per 1,000 patient-days.

Fraser TG, et al. (2010) say that the overriding goal of their intervention was to decrease S. aureus disease in a population of carriers acknowledged to be at high risk for infection, and that a program of active surveillance for S. aureus nasal colonization linked to a decolonization protocol was associated with a decrease in total S. aureus healthcare-acquired infection and ventilator-associated pneumonia caused by S. aureus. They write, "Although we cannot demonstrate causality, the decrease in S. aureus disease and acquisition of nasal colonization that was seen throughout the intervention period has been maintained during the two years after the intervention period. Our experience does not allow us to determine the contributing effect of each component of the decolonization protocol, but the sum total of the intervention has been successful and has encouraged us to improve adherence to the intervention and to expand this program in our attempts to decrease HAI due to a formidable pathogen in all of our intensive care units. We have found this program to be a pragmatic, targeted approach that fits within our infection prevention construct."

Reference: Fraser TG, et al. Decrease in Staphylococcus aureus Colonization and HospitalAcquired Infection in a Medical Intensive Care Unit after Institution of an Active Surveillance and Decolonization Program. Infect Control Hosp Epidemiol. 2010;31:779-783.