Antiseptic Body Washes for Reducing the Transmission of Methicillin-Resistant Staphylococcus aureus: A Cluster Crossover Study

Patrick N A Harris, Bich Diep Le, Paul Tambyah, Li Yang Hsu, Surinder Pada, Sophia Archuleta, Sharon Salmon, Amartya Mukhopadhyay, Jasmine Dillon, Robert Ware, Dale A Fisher, Patrick N A Harris, Bich Diep Le, Paul Tambyah, Li Yang Hsu, Surinder Pada, Sophia Archuleta, Sharon Salmon, Amartya Mukhopadhyay, Jasmine Dillon, Robert Ware, Dale A Fisher

Abstract

Background. Limiting the spread of methicillin-resistant Staphylococcus aureus (MRSA) within healthcare facilities where the organism is highly endemic is a challenge. The use of topical antiseptic agents may help interrupt the transmission of MRSA and reduce the risk of clinical infection. Octenidine dihydrochloride is a topical antiseptic that exhibits in vitro efficacy against a wide variety of bacteria, including S aureus. Methods. We conducted a prospective cluster crossover study to compare the use of daily octenidine body washes with soap and water in patients identified by active surveillance cultures to be MRSA-colonized, to prevent the acquisition of MRSA in patients with negative screening swabs. Five adult medical and surgical wards and 2 intensive care units were selected. The study involved an initial 6-month phase using octenidine or soap washes followed by a crossover in each ward to the alternative product. The primary and secondary outcomes were the rates of new MRSA acquisitions and MRSA clinical infections, respectively. Results. A total of 10 936 patients admitted for ≥48 hours was included in the analysis. There was a small reduction in MRSA acquisition in the intervention group compared with controls (3.0% vs 3.3%), but this reduction was not significant (odds ratio, 0.89; 95% confidence interval, .72-1.11; P = .31). There were also no significant differences in clinical MRSA infection or incidence of MRSA bacteremia. Conclusions. This study suggests that the targeted use of routine antiseptic washes may not in itself be adequate to reduce the transmission of MRSA in an endemic hospital setting.

Keywords: MRSA; colonization; methicillin-resistant Staphylococcus aureus; octenidine; topical antiseptics.

Figures

Figure 1.
Figure 1.
Study design. Abbreviation: ICU, intensive care unit.
Figure 2.
Figure 2.
Study protocol and workflow. Abbreviation: MRSA, methicillin-resistant Staphylococcus aureus.

References

    1. Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003; 36:281–5.
    1. Balm MN, Lover AA, Salmon S et al. . Progression from new methicillin-resistant Staphylococcus aureus colonisation to infection: an observational study in a hospital cohort. BMC Infect Dis 2013; 13:491.
    1. Pada SK, Ding Y, Ling ML et al. . Economic and clinical impact of nosocomial meticillin-resistant Staphylococcus aureus infections in Singapore: a matched case-control study. J Hosp Infect 2011; 78:36–40.
    1. Filice GA, Nyman JA, Lexau C et al. . Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2010; 31:365–73.
    1. Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States: U.S Department of Health and Human Services, 2013. Available at: . Accessed 27 April, 2015.
    1. Cosgrove SE, Sakoulas G, Perencevich EN et al. . Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003; 36:53–9.
    1. Stamm AM, Long MN, Belcher B. Higher overall nosocomial infection rate because of increased attack rate of methicillin-resistant Staphylococcus aureus. Am J Infect Control 1993; 21:70–4.
    1. Coia JE, Duckworth GJ, Edwards DI et al. . Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006; 63(Suppl 1):S1–44.
    1. Humphreys H. National guidelines for the control and prevention of methicillin-resistant Staphylococcus aureus--what do they tell us? Clin Microbiol Infect 2007; 13:846–53.
    1. Siegel JD, Rhinehart E, Jackson M et al. . Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007; 35(10 Suppl 2):S165–93.
    1. Cepeda JA, Whitehouse T, Cooper B et al. . Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 2005; 365:295–304.
    1. Huskins WC, Huckabee CM, O'Grady NP et al. . Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011; 364:1407–18.
    1. Kralovic SM, Evans ME, Simbartl LA et al. . Zeroing in on methicillin-resistant Staphylococcus aureus: US Department of Veterans Affairs’ MRSA Prevention Initiative. Am J Infect Control 2013; 41:456–8.
    1. Fisher D, Tambyah PA, Lin RT et al. . Sustained meticillin-resistant Staphylococcus aureus control in a hyper-endemic tertiary acute care hospital with infrastructure challenges in Singapore. J Hosp Infect 2013; 85:141–8.
    1. Simor AE. Staphylococcal decolonisation: an effective strategy for prevention of infection? Lancet Infect Dis 2011; 11:952–62.
    1. Wertheim HF, Melles DC, Vos MC et al. . The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005; 5:751–62.
    1. Gould IM, MacKenzie FM, MacLennan G et al. . Topical antimicrobials in combination with admission screening and barrier precautions to control endemic methicillin-resistant Staphylococcus aureus in an Intensive Care Unit. Int J Antimicrob Agents 2007; 29:536–43.
    1. Robicsek A, Beaumont JL, Thomson RB Jr et al. . Topical therapy for methicillin-resistant Staphylococcus aureus colonization: impact on infection risk. Infect Control Hosp Epidemiol 2009; 30:623–32.
    1. Ridenour G, Lampen R, Federspiel J et al. . Selective use of intranasal mupirocin and chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007; 28:1155–61.
    1. Bode LG, Kluytmans JA, Wertheim HF et al. . Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010; 362:9–17.
    1. Huang SS, Septimus E, Kleinman K et al. . Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013; 368:2255–65.
    1. Sedlock DM, Bailey DM. Microbicidal activity of octenidine hydrochloride, a new alkanediylbis[pyridine] germicidal agent. Antimicrob Agents Chemother 1985; 28:786–90.
    1. Rohr U, Mueller C, Wilhelm M et al. . Methicillin-resistant Staphylococcus aureus whole-body decolonization among hospitalized patients with variable site colonization by using mupirocin in combination with octenidine dihydrochloride. J Hosp Infect 2003; 54:305–9.
    1. Spencer C, Orr D, Hallam S, Tillmanns E. Daily bathing with octenidine on an intensive care unit is associated with a lower carriage rate of meticillin-resistant Staphylococcus aureus. J Hosp Infect 2013; 83:156–9.
    1. Krishna BV, Gibb AP. Use of octenidine dihydrochloride in meticillin-resistant Staphylococcus aureus decolonisation regimens: a literature review. J Hosp Infect 2010; 74:199–203.
    1. Koburger T, Hubner NO, Braun M et al. . Standardized comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine dihydrochloride, polyhexanide and chlorhexidine digluconate. J Antimicrob Chemother 2010; 65:1712–9.
    1. European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters version 3.1. Available at: Accessed 27 April, 2015.
    1. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13:818–29.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373–83.
    1. Avery TR, Kleinman KP, Klompas M et al. . Inclusion of 30-day postdischarge detection triples the incidence of hospital-onset methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2012; 33:114–21.
    1. Wertheim HF, Vos MC, Ott A et al. . Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet 2004; 364:703–5.
    1. Kluytmans JA, Mouton JW, Ijzerman EP et al. . Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995; 171:216–9.
    1. Goyal N, Miller A, Tripathi M, Parvizi J. Methicillin-resistant Staphylococcus aureus (MRSA): colonisation and pre-operative screening. Bone Joint J 2013; 95-b:4–9.
    1. von Eiff C, Becker K, Machka K et al. . Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 2001; 344:11–6.
    1. van Rijen M, Bonten M, Wenzel R, Kluytmans J. Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers. Cochrane Database Syst Rev 2008; 4:CD006216.
    1. Choudhury S, Krishnan PU, Ang B. Prevalence of high-level mupirocin resistance among meticillin-resistant Staphylococcus aureus isolates in a tertiary care hospital in Singapore. J Hosp Infect 2012; 82:56–7.
    1. Al-Doori Z, Goroncy-Bermes P, Gemmell CG, Morrison D. Low-level exposure of MRSA to octenidine dihydrochloride does not select for resistance. J Antimicrob Chemother 2007; 59:1280–1.
    1. Otter JA, Patel A, Cliff PR et al. . Selection for qacA carriage in CC22, but not CC30, methicillin-resistant Staphylococcus aureus bloodstream infection isolates during a successful institutional infection control programme. J Antimicrob Chemother 2013; 68:992–9.
    1. Batra R, Cooper BS, Whiteley C et al. . Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillin-resistant Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2010; 50:210–7.

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