Introduction: Methicillin-resistant staphylococcus aureus (MRSA) colonization is predictive of invasive infections. Novel strategies to identify and eradicate colonization may reduce MRSA infections.
Hypothesis: The S&D policy reduces the rates of MRSA ventilator associated pneumonias (VAP), central-line associated blood stream infections (CLABSI), catheter associated urinary tract infections (CAUTI), and wound infections in trauma patients.
Methods: National Trauma Registry (NTRACS) data from our rural, university level 1 trauma center was merged with an in-house infection control database of all MRSA screening and nosocomial cultures. The incidences of MRSA infections (VAP, CLABSI, CAUTI, wounds) were compared between a surveillance-only control group (Oct 05-Jan 07) and the S&D group (Feb 07-Dec 11). Starting in Feb. 2007, all admitted patients underwent weekly screening for nasal MRSA colonization using PCR, with decolonization using nasal mupirocin and chlorhexidine baths for those who screened positive. Admission demographics, length-of-stay (LOS) and standard trauma scores were compared between groups. A z-score was used to compare differences in the rates of MRSA infection.
Results: 16,936 patients were included with 13,258 in the S&D group. No clinically significant differences were noted in admission demographics, injury severity, mortality, LOS, or ventilator days between groups. However, in the S&D group, the incidence of MRSA pneumonia fell by 58% (5.5 vs 2.3 MRSA pneumonias per 1000 ventilator days, p=0.003). This effect was noted immediately following the introduction of the S&D policy. The relative incidence of MRSA CLABSI fell by 79% (0.11% vs 0.02%, p=0.022). Reductions in MRSA CAUTI and wound infections were also noted (0.08% vs 0.07%, p=0.78; 0.27% vs 0.20%, p=0.43), though not statistically significant.
Conclusions: Search and destroy is associated with significant decreases in the incidence of MRSA VAP and CLABSI in trauma patients. Decreases in MRSA CAUTI and wound infections were also seen after the implementation of this program. Pre-emptive strategies to identify and eradicate MRSA are worthwhile endeavors in terms of preventing nosocomial infection.
(C) 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins