Decolonization therapy in infection control

Abstract

Hospital acquired infections (HAIs) are costly and are a leading cause of hospital death. Many HAIs originate from patients' own flora. Decolonization strategies aim to prevent infection from these endogenous sources. This review focuses on data published from 2008 to the present on effectiveness and safety of patient decolonization strategies for preventing HAIs. Surgical site infections (SSIs): recent literature confirms that Staphylococcus aureus decolonization to prevent SSIs is effective in cardiac and likely certain orthopedic surgery patients. The benefit to general surgery patients is not clear. Ventilator-associated pneumonia (VAP): although past studies have found that decolonization benefits cardiac surgery patients, recent studies have not found the same benefit in general medical and surgical ICU patients. Blood stream infection (BSI): mupirocin on hemodialysis catheter exit sites is protective against BSI. Chlorhexidine and selective decontamination of the digestive tract have been studied as ways to decrease ICU BSI, but their roles are still being clarified. Methicillin-resistant Staphylococcus aureus (MRSA)-specific decolonization: evidence of benefit to MRSA-colonized nonsurgical patients is lacking. Decolonization is likely an effective infection-control strategy for hemodialysis catheter-associated infections and in cardiac and orthopedic surgery patients. More research is needed on its role in other settings.