Bridging borders: adapting the Orange County methicillin-resistant Staphylococcus aureus decolonization protocol for...

This study aims to evaluate the effectiveness of an adapted methicillin-resistant Staphylococcus aureus (MRSA) decolonization program in an infirmary unit in Hong Kong that was inspired by successful interventions implemented in Orange County, California.

Nasal, skin, and rectal swabs were collected to assess MRSA colonization. Decolonization involved applying 10% povidone-iodine ointment to the anterior nares twice daily for five days every other week, along with twice weekly chlorhexidine gluconate (CHG) bathing for six months. Compliance with the application of povidone-iodine and CHG bathing techniques was monitored by measuring their respective levels in the anterior nares and on the skin. Air and environmental samples were collected and analyzed over time using linear regression.

Among 60 patients in the infirmary unit (78% baseline MRSA carriers), overall MRSA colonization declined during the program, driven by significant reductions in skin colonization (65% to 29%, P < .001). Environmental contamination on high-touch patient-care equipment (bathing trolleys and slings) also significantly decreased over time (P < .001). These reductions coincided with the high-quality implementation of decolonization, evidenced by stable iodophor detection in nares during application weeks and sustained chlorhexidine levels on the skin, detectable 24 hours after bathing. In contrast, MRSA detection in air samples showed no significant change (P = .096), possibly due to dispersal by persistent carriers during care activities even as skin and environmental contamination declined.

The adapted MRSA decolonization program was effective, significantly reducing overall MRSA colonization, especially at skin sites, while achieving high compliance with the protocol.