Pooling relative risks to assess the protective effect of decolonization among studies of cardiac surgery and total joint stents. Povidone iodine has broad activity against both Gram-positive and Gram-negative bacteria. Povidone iodine is applied topically in concentrations of 4% to 10%. It is well tolerated; However, it can cause mild skin irritation. Iodine povidone has a faster bactericidal effect than CHG, but iodine povidone has not been shown to have a lasting effect like CHG (120). One study compared a CHG supplement with a povidone iodine supplement for the use of surgical exfoliation. The authors found that CHG had more persistent activity than povidone iodine (121). Chg is recommended to have more than 10% iodine solutions for catheter placement, as CHG is associated with a lower risk of infection (122). Although iodine povidone has broad-spectrum properties, it is not ideal for topical decolonization as there is no evidence of persistence and lower outcomes than CHG. The effect of non-immediate decolonization of patients and HCWs is discussed in Supplementary Dossier 1.
More importantly, studies have shown that S. aureus, highly resistant to mupirocin, leads to a failure of decolonization. The relationship between LL-MR and the failure of mupirocin decolonization is unclear. Walker et al. (72) published a prospective study to determine the efficacy of nasal mupirocin in decolonized patients with mupirocin-sensitive MRSA (MS MRSA) and mupirocin-resistant MRSA, both LL-MR MRSA and HL-MR MRSA. Patients were given 2% mupirocin twice daily for 5 days. They were then grown on day 3 and weeks 1, 2 and 4 after treatment. Nares cultures on day 3 after treatment were negative in 79% of MS MRSA patients, 80% of LL-MR MRSA patients and 28% of HL-MR MRSA patients. However, at follow-up 1 to 4 weeks later, sustained decolonization was low in patients with HL-MR MRSA and LL-MR MRSA (25% each, compared to 91% in patients colonized with MS MRSA). This result suggests that mupirocin is likely to temporarily suppress the growth of LL-MR MRSA, but will not lead to continued decolonization.
Post-treatment cultures generally had the same genotype and susceptibility phenotypes as the corresponding parent cultures. This seems to show endogenous recolonization and no exogenous colonization. In summary, with the exception of the study by Noto et al. (111) There is now a body of evidence that horizontal approaches involving universal decolonisation with CHG bath and potentially nasal mupirocin may be more effective in endemicity situations than vertical strategies involving active surveillance testing and isolation. These studies support the recently published recommendation that patients in intensive care should be bathed daily with chG for 2 months to prevent CLABSI as a basic practice (103). Although the incidence of resistance to CHG is currently low and of uncertain clinical importance, resistance to CHG needs to be monitored with wider use. Of course, the relative effects of the decolonization of TS depend on the parameters used in the model. For example, at lower endemic concentrations of MRSA, the effects of decolonizing MSW would be relatively higher.
However, dependence on two parameters, the proportion of persistently colonized HCWs and the resulting percentage of acquisitions, remains important in all settings, and the estimation of these parameters in a clinical setting will allow for a more accurate determination of the effectiveness of the decolonization of SCDs in reducing nosocomial transmission of MRSA. The role of persistent colonized health care workers is composed of two aspects: the percentage of persistent colonized health workers (which depends on the probability that a non-colonized health HCW acquires colonization from a colonized patient) and the probability of TScolonized acting as a source. Because of these different aspects, only a few persistent, highly infectious colonized health TSs can transmit MRSA to the same number of patients as many persistently colonized health TSs, who are individually less susceptible to the spread of MRSA. The benefits of decolonizing TS depend largely on these parameters. Notably, this does not include their role as vectors with temporarily contaminated hands, which was considered patient-to-patient transmission. We assessed the prevalence dynamics of MRSA patients for several values in both aspects. The proportion of health care workers who were persistently colonized ranged from 1% to 10%, and the proportion of patient acquisitions resulting from persistently colonized HEALTH OSH ranged from 10% to 50%. We quantified the impact of the monthly, semi-annual, and annual decolonization of HCWs (Figure 2 and Supplementary File 1: Figure S1).
The greatest benefit of the decolonization of HCWs is achieved when only a few persistently colonized health care workers are responsible for much of the acquisitions. Of course, the monthly decolonization of TS is more effective than the semi-annual and annual decolonization, but still less effective than the decolonization of patients with documented transport of MRSA with 100% efficiency. Strategies to reduce and decolonize pathogens can prevent infections and stop the spread of pathogens and their genes. The CDC invests in innovative research projects to identify and implement new ways to respond to antimicrobial resistance. The CDC funds research on pathogen reduction and decolonization, but more research is needed to develop new therapeutic strategies to combat colonization, microbiomes, and health-related and antimicrobial-resistant infections. Based on a theoretical framework, we identified scenarios in which the decolonization of persistent colonized HCWs, either as a stand-alone measure or when added to interventions for colonized patients, can significantly improve THE control of MRSA in healthcare. In general, the decolonization of HCWs becomes more beneficial as their transportation rates decrease while increasing their contribution to patient acquisition (by colonized TSC). Depending on the patient population, different laboratory tests may be suitable for screening. When rapid results are needed, real-time PCR can be used to test nasal swabs for MRSA and MSSA within 1 hour (169). However, PCR is more expensive than chromogenic agar (the test time is at least 1 to 2 days) (170) and standard culture (the test time is about 2 to 3 days) (171). In the preoperative clinic, rapid results may be needed so that patients can be sent home with mupirocin and CHG if necessary, and these decolonizing agents can be used before surgery. Slower methods could be used for other patient populations who have frequent contact with the health care system and longer risk periods and could therefore receive their decolonization officers at their next medical visit (e.g., dialysis patients).
However, any type of screening is likely to be more expensive and certainly consumes more time spent by health workers than general decolonization (160, 161, 165). Universal decolonization could dilute the effects of the decolonization regime. One RCT examined patients prior to surgery for nasal transport of S. aureus, but then treated all patients nasally with mupirocin or placebo before the results of nasal culture were known. This study showed no significant decrease in the total number of infections after surgery, but showed a significant decrease in infections in people colonized with S. aureus (56). In practice, however, the decolonization of patients will be less effective than the decolonization of health care workers [8].
