VANCOUVER, British Columbia (EGMN) – The most effective strategy for preventing colonizations and infections with methicillin-resistant Staphylococcus aureus in ICUs is a combination of universal contact precautions and universal decolonization, according to a computer simulation analysis.

Among a hypothetical cohort of 100,000 adult patients admitted to ICUs, such a combination strategy would prevent an estimated 54% of colonizations and 51% of MRSA infections compared with standard precautions, Dr. Courtney A. Gidengil said at the annual meeting of the Infectious Diseases Society of America.

Standard precautions include careful hand washing by health care workers and appropriate cleaning of the hospital environment. Universal contact precautions involve isolating affected patients in a private room or in a room with other MRSA patients. All health care workers must don gloves and gowns before seeing the patient. Universal decolonization involves daily chlorhexidine gluconate (CHG) baths along with twice-daily applications of mupirocin nasal ointment, both for 5 days.

The next most effective strategy, according to the analysis, would be a combination of universal contact precautions and universal CHG baths, which would prevent about 38% of colonizations and 40% of infections, said Dr. Gidengil of Children’s Hospital Boston and the Rand Corp.

Universal decolonization alone would prevent 34% of colonizations and 40% of infections. Universal contact precautions alone would prevent 29% of colonizations and 26% of infections. And universal CHG baths alone would prevent 12% of colonizations and 23% of infections.

“Our findings are still preliminary and are based on assumptions we’ve made about how often MRSA is transmitted in the hospital and how efficacious different interventions are to prevent MRSA,” Dr. Gidengil said in a press briefing.

Among the assumptions: 10% of patients are colonized on admission, the average ICU length of stay is 4 days, 0.5%-1.5% of patients acquire MRSA colonization each ICU day, and 0.4% develop MRSA infections each colonization day. The model further assumes that CHG baths have an efficacy of 32% for preventing transmission and 25% for preventing infection, and that decolonization has an efficacy of 80% for preventing transmission and 60% for preventing infection.

Dr. Gidengil said the investigators plan to run the model with other assumptions to see how that may affect the results.

The investigators also looked at the costs and savings associated with the various strategies. They assumed that CHG baths cost $2, that decolonization costs $5, and that the excess daily cost of a MRSA infection is $1,250.

Based on those assumptions, the combination of universal contact precautions and universal decolonization would cost $50 per MRSA colonization prevented and $760 per MRSA infection prevented. Universal contact precautions plus universal CHG baths would cost $1,100 per colonization prevented and $14,000 per infection prevented. Universal contact precautions alone would cost $3,250 per colonization prevented and $49,000 per infection prevented.

The investigators determined that two of the strategies – universal CHG baths alone and universal decolonization alone would actually save costs compared with standard precautions, but they did not provide estimates of the magnitude of those cost savings.

Dr Gidengil and her coinvestigators reported having no conflicts of interest. The U.S. Centers for Disease Control and Prevention and the U.S. National Institute of General Medical Sciences funded the study.

Copyright (c) 2010 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

不列颠哥伦比亚省温哥华市 (EGMN)——一项计算机模拟分析显示，预防重症监护室(ICU)中耐甲氧西林金黄色葡萄球菌(MRSA)定植和感染的最有效策略为全面接触预防措施联合全面去定植。

标准预防措施包括医护人员仔细洗手和对医院环境的合理清洁。全面接触预防措施为将受感染者隔离在一个私人病房或与其他MRSA患者隔离在同一个病房，所有医护人员在与患者见面前必须戴无菌手套和穿隔离衣。全面去定植为使用鼻用莫匹罗星软膏、每天2次，同时每日使用葡萄糖酸氯己定(CHG)洗浴，持续5天。

由Courtney A. Gidengil博士带领完成的这项分析研究含有100,000例入住ICU的成人患者。其结果显示，单纯采用全面去定植可预防34%的定植和40%的感染，单纯采用全面接触预防措施可预防29%的定植和26%的感染，而单纯进行全面葡萄糖酸氯己定(CHG)洗浴可预防12%的定植和23%的感染。与标准预防措施相比，全面接触预防措施联合全面去定植可预防54%的定植和51%的MRSA感染，全面接触预防措施联合全面CHG洗浴的效果仅次于以上联合策略，可预防约38%的定植和40%的感染。另据该模型推测，CHG洗浴预防MRSA传播和感染的有效率分别为32%和25%，而去定植预防MRSA传播和感染的有效率分别为80%和60%。

对各种策略的费用进行推测发现，CHG洗浴和去定植的费用分别为2美元和5美元，而1例MRSA感染的日超额费用则为1,250美元。采用全面接触预防措施联合全面去定植后每预防1例MRSA定植或1例MRSA感染所需的费用分别为50美元和760美元。全面接触预防措施联合全面CHG洗浴达到以上预防效果所需的费用分别为1,100美元和14,000美元，而单纯采用全面接触预防措施达到以上预防效果所需的费用分别为3,250美元和49,000美元。全面CHG洗浴和全面去定植这两项策略相对于标准预防措施而言实际上会节省费用。

Gidengil博士及其合作研究者们无相关的利益冲突报告。该研究由美国疾病预防控制中心和美国国家普通医学研究所提供资助。

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