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Selective Use of Intranasal Mupirocin and Chlorhexidine Bathing and the Incidence of Methicillin-Resistant Staphylococcus aureus Colonization and Infection Among Intensive Care Unit Patients

Published online by Cambridge University Press:  02 January 2015

Glenn Ridenour ,
Russell Lampen ,
Jeff Federspiel ,
Steve Kritchevsky ,
Edward Wong  and
Michael Climo
Glenn Ridenour
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
Russell Lampen
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
Jeff Federspiel
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
Steve Kritchevsky
Affiliation:
Department of Internal Medicine, Gerontology, and Geriatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Edward Wong
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
Michael Climo*
Affiliation:
Division of Infectious Diseases, Hunter Holmes McGuire Veterans Affairs Medical Center, and theVirginia Commonwealth University Medical Center, Richmond, Virginia
*
Hunter Holmes McGuire Veterans Affairs Medical Center, 1201 Broad Rock Blvd., Section 111, Richmond, VA 23236 (michael.climo@med.va.gov)
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Abstract

Objective.

To determine whether the use of chlorhexidine bathing and intranasal mupirocin therapy among patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) would decrease the incidence of MRSA colonization and infection among intensive care unit (ICU) patients.

Methods.

After a 9-month baseline period (January 13, 2003, through October 12, 2003) during which all incident cases of MRSA colonization or infection were identified through the use of active-surveillance cultures in a combined medical-coronary ICU, all patients colonized with MRSA were treated with intranasal mupirocin and underwent daily chlorhexidine bathing.

Results.

After the intervention, incident cases of MRSA colonization or infection decreased 52% (incidence density, 8.45 vs 4.05 cases per 1,000 patient-days; P = .048). All MRSA isolates remained susceptible to chlorhexidine; the overall rate of mupirocin resistance was low (4.4%) among isolates identified by surveillance cultures and did not increase during the intervention period.

Conclusions.

We conclude that the selective use of intranasal mupirocin and daily chlorhexidine bathing for patients colonized with MRSA reduced the incidence of MRSA colonization and infection and contributed to reductions identified by active-surveillance cultures. This finding suggests that additional strategies to reduce the incidence of MRSA infection and colonization—beyond expanded surveillance—may be needed.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 10 , October 2007 , pp. 1155 - 1161
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007 

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