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Targeted vs Universal Decolonization: Better Outcomes? Rachel Fields NURS 4100 Walden University Targeted vs Universal Decolonization in ICU: Better Outcomes? When a patient in the Intensive Care Unit develops an infection while they are in the hospi $8.49
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Targeted vs Universal Decolonization: Better Outcomes? Rachel Fields NURS 4100 Walden University Targeted vs Universal Decolonization in ICU: Better Outcomes? When a patient in the Intensive Care Unit develops an infection while they are in the hospi
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Targeted vs Universal Decolonization: Better Outcomes? Rachel Fields NURS 4100 Walden University Targeted vs Universal Decolonization in ICU: Better Outcomes? When a patient in the Intensive Care Unit develops an infection while they are in the hospital, it is known as a hospital acquired...

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  • December 8, 2022
  • 23
  • 2022/2023
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Targeted vs Universal Decolonization: Better Outcomes?

Rachel Fields

NURS 4100

Walden University




Targeted vs Universal Decolonization in ICU: Better Outcomes?
When a patient in the Intensive Care Unit develops an infection while they are in the

hospital, it is known as a hospital acquired infection. Most commonly these infections are

caused by a type of staph that has become resistant to many antibiotics and is known as

Methicillin-resistant staphylococcus aureus (MRSA). The National Healthcare Safety Network,

part of the Centers for Disease Control and Prevention (CDC) states, that MRSA infections in

healthcare settings are the most severe and potentially life threatening (Centers for Disease


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Control, 2018). Along with patient risk, these infections cost hospitals thousands of dollars

each year and Medicare and Medicaid does not reimburse for hospital acquired infections.

There are two ways that Intensive Care Units (ICU) are working to combat infections like

these, and they develop protocols for either targeted or universal decolonization. The targeted

approach consists of a rapid MRSA nasal swab, followed by 5 days of contact isolation and daily

chlorhexidine baths. If the nasal swab is found to be positive, the patients are also treated with

intra-nasal mupirocin ointment twice a day for five days and retested again on day 7. They are

swabbed weekly until they have two consecutive negative swabs. The use of the universal

decolonization method includes no screening for MRSA on admission, patients with a history of

MRSA (carriers) are put on contact precautions, and all patients are given chlorhexidine baths

daily as well as treated with five days of intra-nasal mupirocin (Huang, S., Septimus, E.,

Kleinman, K., Moody, J., Hickok, J., Avery, T., Lankiewicz, J., Gombosev, A., Terpestra, L.,

Hartford, F., Hayden, M., Jernigan, J., Weinstein, R., Fraser, V., Haffenreffer, K., Cui, E., Kaganov,

R., Lolans, K., Perlins, J., Platt, R., for the CDC Prevention Epicenters Program and the AHRQ

DECIDE network and Healthcare-Associated Infections Program, 2013). Universal decolonization

eliminates the waiting time between swabbing and treatment as well as the cost from

unnecessarily using contact isolation supplies (personal protective equipment and cleaning

supplies).

The reduction of blood stream infections with the use of universal decolonization can be

nearly 40% as well as cost reduction (Huang et al, 2013). The decrease in blood stream

infections can be linked also to a decreased rate of catheter related blood stream infections,

also most commonly staph (Kirby, 2014). The cost of care per day in the intensive care unit is

25% less for patients without infections as compared to those who test positive for blood


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stream infections. Is there evidence to support the change from targeted decolonization to

universal decolonization? Would the use of universal decolonization for patients admitted to

the intensive care unit both reduce blood stream infections and health care costs compared to

targeted decolonization? The purpose of this paper is to address the evidence behind this

recommended practice change as well as introduce the plan for how implement this change.




Recommended Change in Practice

The current practice for adult patients admitted to the intensive care unit is to swab

both anterior nares with sterile culture swab. The specimen in then sent to lab for confirmation

by coagulase testing and the use of plasma agglutination assay as well as polymerase chain

reaction (PCR) to detect mecA genes (Oh-Hyun Cho, Eun Hwa Baek, Mi Hui Bak, Young Sun Suh,

KiHo Park, Sunjoo Kim, In-Gyu Bae and Sun Hee Lee, 2016). Patients with a known history of a

positive MRSA culture are put on contact isolation. These precautions are lifted if the PCR swab

obtained on admission comes back negative. Positive PCR results remain on contact isolation

and treated with chlorhexidine baths and mupirocin ointment applied to the nares twice a day.

The goal of the practice change would be to reduce hospital acquired MRSA infections

and reduce treatment cost of both PCR positive patients and those that become colonized

during their hospitalization. Moving to a universal decolonization protocol would reduce the

rates of

MRSA in clinical cultures and blood stream infections from any pathogen (Huang et al., 2013).

Several studies have shown that daily chlorhexidine baths alone can reduce the surface

concentration of bacteria on the body which precludes the decrease in the acquisition of MRSA

colonization while hospitalized (Huang et al., 2013). The use of universal decolonization can


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