Isolation for MRSA Isn't the Answer

July 1, 2013

Isolation for MRSA Isn't the Answer

  1. Patricia Kritek, MD

Universal decontamination of intensive care unit patients resulted in fewer bloodstream infections and methicillin-resistant Staphylococcus aureus cultures.

  1. Patricia Kritek, MD

To prevent nosocomial infections, most hospitals routinely screen intensive care unit (ICU) patients for methicillin-resistant Staphylococcus aureus (MRSA) and place carriers in contact precautions. This process is costly for hospitals and isolating for patients. An alternative approach is skin and nares decontamination through chlorhexidine bathing, and intranasal mupirocin. To determine the relative effectiveness of these strategies, investigators conducted an 18-month trial in which 43 hospitals (74,000 patients) were randomized to either MRSA screening with isolation, targeted decontamination (only patients with positive MRSA screens), or universal decontamination (all ICU patients).

Compared with baseline risk, risk during universal decontamination was significantly lower for MRSA-positive clinical cultures (hazard ratio, 0.63) and for bloodstream infections from any pathogen (HR, 0.56). Screening and isolation did not affect risk for these events (HRs, 0.92 and 0.99, respectively). Targeted decontamination results were intermediate (HRs, 0.75 and 0.78, respectively). No strategy significantly lowered risk for MRSA bloodstream infections. Adverse events (skin rash or pruritus in 7 patients in the decontamination groups) were mild and related to chlorhexidine sensitivity.


These results strongly suggest that it's time for hospitals to reconsider the policy of screening and isolation; indeed, editorialists contend that “the lack of effectiveness of active detection and isolation should prompt hospitals to discontinue the practice for control of endemic MRSA.” Because this strategy is mandated in some states, immediate change will not be feasible everywhere. Important questions remain, including whether universal decontamination is cost-effective on a larger scale and whether it facilitates pathogen resistance. Early-adopting institutions should study these aspects of universal decontamination to guide wider-scale adoption of this practice.

  • Disclosures for Patricia Kritek, MD at time of publication Editorial boards ACP Medicine; New England Journal of Medicine


Reader Comments (2)

Louis Kennedy Physician, Hospital Medicine, Providence Care

How about simply antibiotic stewardship, avoidance of quinolones and excellent hand hygiene. In my opinion these measures are about as good as it can get.

DALE HAVRE Physician, Ophthalmology

How about decontaminating hospital staff, especially in operating rooms?

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