Infection control · Decolonisation strategy
Targeted versus universal decolonization to prevent ICU infection
| Design | Cluster-randomised trial in 43 hospitals |
|---|---|
| Treatment | Universal decolonisation of all ICU patients with chlorhexidine bathing and nasal mupirocin |
| Control | Targeted decolonisation of MRSA carriers, or screening and isolation |
| Population | 74 ICUs in 43 hospitals with 74,256 patients during the intervention period |
| Follow-up | 18-month intervention period |
| Primary endpoint | MRSA clinical isolates and all-cause bloodstream infection |
| Result | Modelled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation, 0.75 for targeted decolonisation and 0.63 for universal decolonisation (p=0.01 across groups; crude rates 2.1 versus 3.4 isolates per 1000 days for universal decolonisation). For bloodstream infection with any pathogen the hazard ratios were 0.99, 0.78 and 0.56 respectively (3.6 versus 6.1 infections per 1000 days for universal decolonisation). |
| Secondary endpoints | Bloodstream infection from any pathogen, adverse events |
In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen.
The trial authors, in the published abstract
Overturned the screen-and-isolate paradigm and made universal chlorhexidine bathing standard in many ICUs. The unresolved cost is selection pressure — mupirocin and chlorhexidine resistance — which the trial was not designed to detect.
Huang SS, Septimus E, Kleinman K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013 Jun 13;368(24):2255-65.