Epidemiology of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci (VRE) among intensive care unit patients and the impact of active surveillance and chlorhexidine gluconate bathing to reduce skin colonization
Elizabeth A. Kleiner
Preceptor: Gonzalo Bearman, MD, MPH
Preceptor: Michael Climo, MD
Purpose: The primary outcome is to determine the prevalence and incidence of VRE and MRSA skin colonization in an intensive care unit and define the efficacy of active surveillance in identifying previously unrecognized cases of colonization.
Methods: During a 15-month period, patients admitted to an intensive care unit were prospectively screened for VRE and MRSA carriage on admission and discharge. Patients with positive cultures were placed in isolation and on contact precautions. During the second half of the study, a skin decolonization protocol using chlorhexidine gluconate detergent and topical mupirocin was initiated. The prevalence on admission and the rate of VRE and MRSA nosocomial colonization and infection were monitored.
Results: A significant number of patients colonized with VRE or MRSA on admission to the intensive care unit were only recognized through active surveillance. Active surveillance increased the detection of VRE by 140% (78/110 or 71%) and the detection of MRSA by 100% (28/56 or 50%). With the implementation of the decolonization protocol, the incidence of VRE decreased from 11.3% to 4.9% (p=0.015) and the incidence of MRSA decreased from 4.7% to 1.1% (p=0.029).
Conclusions: Targeting hospital units at high risk for colonization and thus transmission of VRE and MRSA with aggressive surveillance and isolation as part of a multi-factorial intervention is an effective strategy to increase the detection of colonized patients. Prompt isolation of these patients with the use of skin decolonization significantly decreases the rate of nosocomial transmission of VRE and MRSA.
