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Updated: Aug 15, 2026
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Significant reduction in methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia associated with
1Division of Pulmonary, Critical Care and Occupational Medicine, Vencor-Tampa Hospital, FL, USA.
Objective:
To determine whether the institution of a methicillin-resistant Staphylococcus aureus prevention protocol was associated with a decrease in methicillin-resistant S. aureus ventilator-associated pneumonia in long-term, acute care ventilator patients.
Design:
A retrospective chart review comparing the number of episodes of clinical pneumonia per patient ventilator day in the 12 months preceding and 24 months following the introduction of the protocol.
Setting:
University affiliated, long-term, acute care ventilator hospital.
Patients:
Long-term, acute care ventilated patients who presented with clinical pneumonia.
Interventions:
Addition of a methicillin-resistant S. aureus prevention protocol. In addition to universal precautions, the protocol consisted of mupirocin 2% ointment applied to the anterior nares, and whole body washing with chlorhexidine. All patients were given mupirocin and chlorhexidine twice weekly. Patients were cohorted in the same room if they were, or had been, infected or colonized with methicillin-resistant S. aureus in any anatomical location or at any time. This procedure replaced strict isolation of methicillin-resistant S. aureus-infected or colonized individuals.
Measurements And Main Results:
Clinical pneumonia was diagnosed when a patient developed fever, bronchorrhea, increased white blood cell count, methicillin-resistant S. aureus isolated from the tracheal aspirate, and new or increasing infiltrate on chest roentgenograph. During the 12 months preceding the protocol, there were 0.2% episodes of methicillin-resistant S. aureus ventilator-associated pneumonia per ventilated patient day compared with 0.026% in the 24 months after the protocol (p < .001). The relative and absolute risk reductions associated with the introduction of the protocol were 87% and 6, respectively.
Conclusions:
The period following the institution of the protocol showed a significant reduction in episodes of clinical pneumonia compared with the 12-month period preceding the use of the protocol (p < .001). Thus, we conclude that the introduction of this protocol is associated with a significant decrease in methicillin-resistant S. aureus ventilator-associated pneumonia.
Insights
A new protocol significantly reduced methicillin-resistant Staphylococcus aureus (MRSA) ventilator-associated pneumonia in long-term acute care patients. The intervention, including mupirocin and chlorhexidine, decreased MRSA pneumonia by 87%.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Hospital Epidemiology
Background:
- Ventilator-associated pneumonia (VAP) is a significant complication in long-term acute care facilities.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen causing VAP, leading to increased morbidity and mortality.
- Effective prevention strategies are crucial to reduce the incidence of MRSA VAP.
Purpose of the Study:
- To evaluate the impact of a comprehensive MRSA prevention protocol on the incidence of MRSA VAP.
- To assess the effectiveness of mupirocin nasal application and chlorhexidine whole-body washing in a long-term acute care ventilator population.
Main Methods:
- A retrospective chart review was conducted in a university-affiliated long-term acute care hospital.
- The study compared MRSA VAP rates per patient ventilator day in the 12 months before and 24 months after protocol implementation.
- The protocol involved universal precautions, mupirocin nasal ointment, chlorhexidine body washing, and patient cohorting based on MRSA status.
Main Results:
- The incidence of MRSA VAP decreased from 0.2% per patient ventilator day before the protocol to 0.026% after its introduction (p < .001).
- The protocol was associated with an 87% relative risk reduction and a 6 absolute risk reduction in MRSA VAP.
- The diagnostic criteria for clinical pneumonia included fever, bronchorrhea, elevated white blood cell count, positive tracheal aspirate for MRSA, and new/increasing chest roentgenograph infiltrate.
Conclusions:
- Implementation of the MRSA prevention protocol led to a statistically significant reduction in MRSA ventilator-associated pneumonia.
- The protocol, combining mupirocin and chlorhexidine with cohorting, is an effective strategy for controlling MRSA VAP in this patient population.
- These findings support the adoption of similar protocols in long-term acute care settings to combat healthcare-associated infections.
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