Determining the Value of Screening and Decolonization in Burn Unit Management

Area of Science:

• Infectious Diseases
• Burn Care
• Quality Improvement

Background:

• Methicillin-resistant Staphylococcus aureus (MRSA) is linked to severe complications and poor outcomes in burn patients.
• Burn centers often use MRSA screening and decolonization to reduce transmission and infections.
• The Ohio State University Wexner Medical Center (OSUWMC) implemented a two-phase quality improvement project for MRSA screening.

Purpose of the Study:

• To evaluate the impact of MRSA decolonization protocols on reducing MRSA incidence, length of stay (LOS), and wound infections in burn patients.
• To compare outcomes between a phase with MRSA decolonization and a phase without decolonization measures.

Main Methods:

• Phase 1 involved MRSA screening and decolonization (intranasal mupirocin and chlorhexidine baths) for positive patients.
• Phase 2 involved MRSA screening but no decolonization measures.
• Patient data on MRSA status, wound infections, LOS, and mortality were collected and analyzed across both phases.

Main Results:

• In Phase 1, 4 out of 45 patients developed MRSA wound infections. In Phase 2, 13 out of 103 patients developed non-MRSA wound infections.
• No significant differences were observed in length of stay, infection incidence (adjusted for TBSA), or mortality between the two phases.
• The study indicated that the costs and resources for screening and decolonization did not yield a substantial clinical benefit.

Conclusions:

• Routine MRSA decolonization protocols in burn patients may not offer significant clinical advantages in reducing MRSA infections or length of stay.
• Further research is needed to determine the cost-effectiveness and clinical utility of MRSA screening and decolonization in specific burn patient populations.
• The findings suggest a need to re-evaluate current MRSA management strategies in burn care settings.