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Alcohol-based Nasal Decolonization and Chlorhexidine Bathing to Reduce Methicillin-resistant Staphylococcus Aureus Hospital-acquired Infections in Critical Patients

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      Background

      Infections associated with multi-drug resistant organisms [MDRO] are difficult to treat due to antibiotic resistance, increased mortality, prolonged length of stay, and hospitalization costs. Patients severely immunocompromised, such as patients in the intensive care unit [ICU], are often at higher risk. The purpose of this pilot study was to evaluate the effectiveness of a universal decolonization protocol within the critical care population of a large academic medical facility. The approach utilized an alcohol-based nasal decolonization agent and chlorhexidine gluconate [CHG] bathing to reduce hospital-acquired laboratory identified (LabID) methicillin-resistant Staphylococcus aureus (MRSA) blood infections.

      Methods

      The pilot included admitted ICU patients meeting inclusion criteria from February 2021 to July 2021. Education and integration of orders occurred in January 2021. Patients received nasal decolonization twice daily, along with daily CHG bathing. LabID MRSA blood events were recorded in the National Healthcare Safety Network [NHSN]. Infections were tracked pre-and-post implementation to evaluate intervention effectiveness. Baseline data was collected from July 2020 to December 2020 from the NHSN database.

      Results

      There was a noted reduction of LabID MRSA hospital-associated infection [HAI] events, decreasing from eight events pre-implementation (July 2020 – December 2020) to three events post-implementation (February 2021-July 2021). While not deemed statistically significant for this short study period as indicated by a two-tailed t-test (p-value 0.19, CI 95% [-0.56,2.23]), the overall reduction in HAI should be considered relevant to patient outcomes and overall infection prevention considerations.

      Conclusions

      The use of decolonization protocols has consistently been associated with improved outcomes and reduction of MRSA infections within literature. Reduction of infection is crucial for patient safety and quality outcomes. This pilot study noted a 62.5% decrease in hospital-associated LabID MRSA infection events after implementation of an alcohol-based nasal decolonization agent in combination with CHG bathing for ICU patients. This is in alignment with other published studies.
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