SIGNIFICANT REDUCTION IN METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS VENTILATOR-ASSOCIATED PNEUMONIA ASSOCIATED WITH THE INSTITUTION OF A PREVENTION PROTOCOL

Objective: To determine whether the institution of a methicillin-resis tant Staphylococcus aureus prevention protocol was associated with a d ecrease in methicillin-resistant S. aureus ventilator-associated pneum onia in long-term, acute care ventilator patients. Design: A retrospec tive chart review comparing the number of episodes of clinical pneumon ia per patient ventilator day in the 12 months preceding and 24 months following the introduction of the protocol. Setting: University affil iated, 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 preventi on protocol. In addition to universal precautions, the protocol consis ted 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 i f they were, or had been, infected or colonized with methicillin-resis tant S. aureus in any anatomical location or at any time. This procedu re replaced strict isolation of methicillin-resistant S. aureus-infect ed or colonized individuals. Measurements and Main Results: Clinical p neumonia was diagnosed when a patient developed fever, bronchorrhea, i ncreased white blood cell count, methicillin-resistant S. aureus isola ted from the tracheal aspirate, and new or increasing infiltrate on ch est roentgenograph. During the 12 months preceding the protocol, there were 0.2% episodes of methicillin-resistant S. aureus ventilator-asso ciated pneumonia per ventilated patient day compared with 0.026% in th e 24 months after the protocol (p < .001). The relative and absolute r isk reductions associated with the introduction of the protocol were 8 7% and 6, respectively. Conclusions: The period following the institut ion of the protocol showed a significant reduction in episodes of clin ical pneumonia compared with the 12-month period preceding the use of the protocol (p < .001). Thus, we conclude that the introduction of th is protocol is associated with a significant decrease in methicillin-r esistant S. aureus ventilator-associated pneumonia.