No abstract

Active surveillance for S. aureus nasal carriage combined with decolonization was associated with a decreased incidence of S. aureus colonization and hospital-acquired infection.

Objective.To evaluate the effects of an active surveillance program forStaphylococcus aureuslinked to a decolonization protocol on the incidence of healthcare-associated infection and new nasal colonization due toS. aureus.Design.Retrospective quasi-experimental study.Setting.An 18-bed medical intensive care unit at a tertiary care center in Cleveland, Ohio.Methods.From January 1, 2006, through December 31, 2007, all patients in the medical intensive care unit were screened forS. aureusnasal carriage at admission and weekly thereafter. During the preintervention period, January 1 through September 30,2006, only surveillance occurred. During the intervention period, January 1 through December 31,2007,S. aureuscarriers received mupirocin intranasally. Beginning in February 2007, carriers also received Chlorhexidine gluconate baths.Results.During the preintervention period, 604 (73.7%) of 819 patients were screened forS. aureusnasal carriage, yielding 248 prevalent carriers (30.3%). During the intervention period, 752 (78.3%) of 960 patients were screened, yielding 276 carriers (28.8%). The incidence ofS. aureuscarriage 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) (P= .04; relative risk [RR], 0.53 [95% confidence interval {CI}, 0.28-0.97]) and from 9.57 to 4.77 cases per 1,000 at-risk patient-days (P= .02; RR, 0.50 [95% CI, 0.27-0.91]). The incidence ofS. aureushospital-acquired bloodstream infection during the 2 periods was 2.01 and 1.11 cases per 1,000 patient-days, respectively (P= .28). The incidence ofS. aureusventilator-associated pneumonia decreased from 1.51 to 0.18 cases per 1,000 patient-days (P= .03; RR, 0.12 [95% CI, 0.01-0.83]). The total incidence ofS. aureushospital-acquired infection decreased from 3.52 to 1.29 cases per 1,000 patient-days (P= .03; RR, 0.37 [95% CI, 0.14-0.90]).Conclusions.Active surveillance forS. aureusnasal carriage combined with decolonization was associated with a decreased incidence ofS. aureuscolonization and hospital-acquired infection.