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. 2020 Feb 26;17(5):1500.
doi: 10.3390/ijerph17051500.

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

Christopher T Short  1 , Matthew S Mietchen  1 , Eric T Lofgren  1
Affiliations

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

Christopher T Short et al. Int J Environ Res Public Health. .

Abstract

Healthcare-associated transmission of methicillin-resistant Staphylococcus aureus (MRSA)remains a persistent problem. The use of chlorhexidine gluconate (CHG) as a means of decolonizingpatients, either through targeted decolonization or daily bathing, is frequently used to supplementother 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 andmortality in an 18-bed intensive care unit, based on a previous model. A scenario with nointervention is compared to CHG bathing, which decolonizes patients but provides no additionalprotection, and a hypothetical treatment that both decolonizes them and provides protection fromsubsequent colonization. The duration and effectiveness of this protection is varied to fully explorethe potential utility of such a treatment. Increasing the effectiveness of the decolonizing agentreduces 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 ofsynergy between the two.

Keywords: MRSA; decolonization; hospital epidemiology.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of the compartmental flow of a mathematical model of methicillin-resistant Staphylococcus aureus transmission in an intensive care unit. Arrows indicate possible transition states. Nurses and doctors are classified as uncontaminated or contaminated (NU/DU and NC/DC respectively), while patients may be uncolonized (PU), colonized (PC), temporarily protected from colonization (PP) and bacteremic (PB).
Figure 2
Figure 2
Structured layout of an intensive care unit. Patients (teal) are treated by a single assigned nurse (orange), while a single intensivist (red) randomly treats all patients in the ward. Figure by Eric Lofgren is licensed under CC-BY-4.0.
Figure 3
Figure 3
Scatterplot of incident MRSA acquisitions in an 18-bed ICU over a simulated year. Each dot represents one of 10,000 iterations of a stochastic model, simulating a spread of possible levels of effectiveness and duration of protection for a hypothetical long-acting decolonization agent.
Figure 4
Figure 4
Scatterplot of incident MRSA-related bacteremia cases in an 18-bed ICU over a simulated year. Each dot represents one of 10,000 iterations of a stochastic model, simulating a spread of possible levels of effectiveness and duration of protection for a hypothetical long-acting decolonization agent.
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