Assessing the Potential Impact of a Long-Acting SkinDisinfectant in the Prevention of Methicillin-Resistant Staphylococcus aureus Transmission.

Christopher T Short,Matthew S Mietchen,Eric T Lofgren

doi:10.3390/ijerph17051500

Abstract

Healthcare-associated transmission of methicillin-resistant Staphylococcus aureus (MRSA) remains a persistent problem. The use of chlorhexidine gluconate (CHG) as a means of decolonizing patients, either through targeted decolonization or daily bathing, is frequently used to supplement other interventions. We explore the potential of a long-acting disinfectant with a persistent effect, immediate decolonizing action in the prevention of MRSA acquisition, and clinical illness and mortality in an 18-bed intensive care unit, based on a previous model. A scenario with no intervention is compared to CHG bathing, which decolonizes patients but provides no additional protection, and a hypothetical treatment that both decolonizes them and provides protection from subsequent colonization. The duration and effectiveness of this protection is varied to fully explore the potential utility of such a treatment. Increasing the effectiveness of the decolonizing agent reduces colonization, with a 10% increase resulting in a colonization rate ratio (RR) of 0.89 (95% CI: 0.89,0.90). Increasing the duration of protection results in a much more modest reduction, with a 12-hour increase in protection resulting in an RR of 0.99 (95% CI: 0.99, 0.99). There is little evidence of synergy between the two.

Highlights

The prevention of healthcare-associated infections (HAI) is a pressing issue to the medical community, governmental agencies, and patient advocacy groups
[4], we represented the transmission of methicillin-resistant Staphylococcus aureus (MRSA) as a stochastic compartmental model, which both the colonization statusmodel-based of a patient, as well as the Extending the previous modelcaptures of an intensive carecurrent unit (ICU)
Nurses of chlorhexidine gluconate (CHG) effectiveness [4], we represented the transmission of MRSA as a stochastic compartmentaland physicians can be both uncontaminated (N U and Dstatus u respectively) or ascontaminated

Summary

Introduction

The prevention of healthcare-associated infections (HAI) is a pressing issue to the medical community, governmental agencies, and patient advocacy groups. While there are relatively straightforward interventions, such as hand hygiene, that can deliver substantial gains, some pathogens such as methicillin-resistant Staphylococcus aureus have proven stubbornly persistent, causing an estimated 120,000 bloodstream infections and 20,000 deaths in the United States [1] This necessitates the use of the “Swiss Cheese” approach, where multiple imperfect interventions (due to non-compliance, clinical demands, antimicrobial resistance, etc.) are put in place in the hope that, when combined, they will have a substantial effect on reducing the burden of HAIs. The use of chlorhexidine gluconate (CHG) is one such intervention, intended to disinfect the skin of a patient, and is applied either immediately before a procedure (such as surgery) or as part of a daily bathing regimen. Previous modeling work by Lofgren et al [4] estimates that the actual per-use effectiveness of CHG bathing is relatively low, suggesting the potential for substantial improvement in either the administration or mechanism of action

Methods

Discussion

Conclusion