New Era In Infection Control: Universal Decolonization Replaces Universal Screening

Vancouver General Hospital, a global leader in infection control, has implemented our MRSAid Photodisinfection System as part of its standard perioperative program to reduce surgical site infections (SSIs). Under this new program, all patients prior to major elective surgeries and emergency surgeries wherever possible will undertake this proactive new infection control measure. With very high patient compliance rates (98%) and no resistance generation, universal decolonization with MRSAid has demonstrated significant SSI reductions as well as ease of integration into the perioperative surgical workflow.

Unlike antibiotics, photodisinfection does not generate bacterial resistance. It is therefore possible to decolonize everyone rather than the select few patients with the most dangerous pathogens. This universal decolonization program eliminates both Staph and MRSA from the nose, ground zero for bacterial colonization. Studies have demonstrated that by eliminating bacteria in the nose prior to surgery results in significant reductions in surgical site infections. Data released by Vancouver General Hospital showed that the use of MRSAid with chlorhexidine body wipes reduced surgical site infections by 39%.

Under traditional universal screening protocols, all patients are screened for MRSA 1-2 weeks in advance of surgery. Patients identified as MRSA carriers are given a topical antibiotic for home use for 5 days prior to surgery. Studies have identified that patient compliance rates for antibiotics are a disappointing 35%, despite the patient’s understanding that they are MRSA carriers and are at great risk for a serious infection after surgery.

Universal decolonization, used extensively in the UK and in some parts of the US, replaces this traditional method of infection control. In fact, the United Kingdom has become the leader of this infection control procedure, having adopted it throughout the National Health Service as a means to reduce MRSA infections post surgery.

MRSA, while very costly and potentially lethal due to its resistance to most antibiotics, is found in up to 10% of patients. Staph, however, is present in 1 in 3 patients and is responsible for majority of SSIs. With new universal decolonization protocols using MRSAid, SSIs are expected to be reduced by ~40%. This will generate significant improvement in patient safety and reductions to unnecessary healthcare costs.

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One Response to “New Era In Infection Control: Universal Decolonization Replaces Universal Screening”

  1. Jose Mediavilla says:

    As a MRSA researcher, I have to caution against the concept of “universal decolonization”, which seems to be gaining traction. Several studies have found very high prevalences of a plasmid-borne gene (mupA or ileS-2) which confers high level resistance to mupirocin (= Bactroban, the topical antibiotic ointment used for nasal decolonization) in USA300 community MRSA infections in San Francisco, Chicago, and Boston. Our own unpublished studies found that 21% of USA300 CA-MRSA infections collected in New York City in 2004-2006 contained the mupA gene. Since USA300 is the most common MRSA in the USA, and is itself highly transmissible, and since genes carried on plasmids are likewise highly transmissible, to embrace universal decolonization in the absence of prior screening will almost certainly increase the prevalence of mupA, thereby rendering mupirocin decolonization increasingly ineffective for high-risk patients who require it. It is astounding to me that at this point in time, researchers and clinicians would embrace such a practice, which runs completely counter to current principles of antibiotic stewardship.

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