Beyond the Intensive Care Unit (ICU): Countywide impact of universal ICU staphylococcus aureus decolonization

Bruce Y. Lee, Sarah M. Bartsch, Kim F. Wong, James A. McKinnell, Eric Cui, Chenghua Cao, Diane S. Kim, Loren G. Miller, Susan S. Huang

Research output: Contribution to journalArticle

Abstract

A recent trial showed that universal decolonization in adult intensive care units (ICUs) resulted in greater reductions in all bloodstream infections and clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) than either targeted decolonization or screening and isolation. Since regional health-care facilities are highly interconnected through patient-sharing, focusing on individual ICUs may miss the broader impact of decolonization. Using our Regional Healthcare Ecosystem Analyst simulation model of all health-care facilities in Orange County, California, we evaluated the impact of chlorhexidine baths and mupirocin on all ICU admissions when universal decolonization was implemented for 25%, 50%, 75%, and 100% of ICU beds countywide (compared with screening and contact precautions). Direct benefits were substantial in ICUs implementing decolonization (a median 60% relative reduction in MRSA prevalence). When 100% of countywide ICU beds were decolonized, there were spillover effects in general wards, long-term acute-care facilities, and nursing homes resulting in median 8.0%, 3.0%, and 1.9% relative MRSA reductions at 1 year, respectively. MRSA prevalence decreased by a relative 3.2% countywide, with similar effects for methicillin-susceptible S. aureus. We showed that a large proportion of decolonization's benefits are missed when accounting only for ICU impact. Approximately 70% of the countywide cases of MRSA carriage averted after 1 year of universal ICU decolonization were outside the ICU.

Original languageEnglish (US)
Pages (from-to)480-489
Number of pages10
JournalAmerican journal of epidemiology
Volume183
Issue number5
DOIs
StatePublished - Mar 1 2016

Keywords

  • MRSA
  • MSSA
  • decolonization
  • hospitals
  • intensive care unit
  • nursing homes

ASJC Scopus subject areas

  • Epidemiology

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