Decolonization in Prevention of Health Care-Associated Infections

Abstract

SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused onS. aureusdecolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent forS. aureusnasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well asCandida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

Temporal trends and epidemiology of Staphylococcus aureus surgical site infection in the Swiss surveillance network: a cohort study

“…preoperatively in cardiac surgery patients). [5][6][7] Therefore, studies investigating the profile of patients at high risk of S. aureus SSI are needed.…”

Administering medication as a part of nursing care at ICU

“…Analýzou dat bylo postupně identifikováno 5 hlavních kategorií popisující tuto praxi: 1. indikace přípravků, 2. výběr prostředků, 3. interval použití, 4. specifika použití a zacházení s přípravky, 5. dokumentace. 1,3,4,5,7,9,11,12,13,14,15,19,20,23,25) b) Doporučení lékaře specialisty (proband 3, 4, 13, 15, 17, 21, 25) c) Pravidla zdravotnického zařízení (proband 1, 5, 10) d) Zvyklost pracoviště (proband 1,2,3,4,5,8,9,10,11,12,13,14,15,16,17,19,21,22,25) e) Sestra u lůžka (proband 1,2,3,4,6,7,8,9,11,12,13,15,17,18,…”

“…Spolupracovníci (proband 1, 3-7, 13, 15, 17, 19-21, 24, 25) Znalosti a zkušenosti (proband 1-25) Pravidla zdravotnického zařízení (proband 1-3, 5, 6, 8-11, 13-16, 18, 20, 25) Zvyklost pracoviště (proband 1-5, 7-20, 23-25) Stupeň intenzivní péče (proband 4-7, 10, 13, 15-19, 23, 25) Zdravotní stav (proband 1, 3-7, 11-18, 21-23, 25) Věk pacienta (proband 2,11,22,25) Koncepty péče (proband 11, 15, 23, 25) Denní doba (proband 7, 17, 22, 25) Komplikace (proband 1,3,12,14,15,17,23,25) Standard péče (proband 3,5) Objednávkový systém (proband 1,15) Přípravky objednávající (proband 1,15,23,25) Další péče (proband 11,13,21,23) Dosavadní péče (proband 11,17,23) Mikrobiologický nález (proband 1,12,15,17,23,25) Předchozí použití prostředku sestrou (proband 11, 23, 25) 3,4,5,7,…”

Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial

“…Colonization with MRSA typically precedes infection and plays a major role in its dissemination in hospitals (2). Both targeted decolonization (i.e., decolonization of patients who are identified as carrying MRSA) and universal decolonization (i.e., decolonization of populations of hospital patients regardless of MRSA colonization status) have been demonstrated to decrease cross-transmission and infection (3,4).…”

“…Antiseptic bathing of patients, most commonly with chlorhexidine gluconate (CHG), is another evidence-based approach to MRSA decolonization; antiseptic baths are often employed together with nasal mupirocin (4,13,14). CHG kills by binding covalently to the bacterial cell membrane, resulting in depolarization and cell death.…”