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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Cutting MRSA Infections Post-Discharge

Hospitalization can increase the risk for acquiring an infection and sadly, that’s what infection preventionists like myself try to prevent.

Hospitalization can result in exposure to a number of organisms that prey on substandard hand hygiene and environmental disinfection. Multidrug-resistant organisms, like methicillin-resistant Staphylococcus aureus (MRSA), are just one of the germs that are easily spread through these environments.

As the US Centers for Disease Control and Prevention (CDC) reports, progress has stalled at preventing health care-associated MRSA and S aureus, with cases on the rise in the community.
Even if a patient doesn’t experience an infection as a result of MRSA during hospitalization, it is still possible to bring the organism home, which can result in an infection later. As a result of these issues, infection prevention efforts seek to reduce not only the transmission of diseases during hospitalization, but to halt diseases from spreading to the home environments of patients and their visitors.

The painful reality of the risks of MRSA colonization emphasize the importance of not only hospital practices, but also discharge education. A new study, published in the New England Journal of Medicine, coined Project CLEAR, has drawn attention to these post-hospital MRSA infections. The project studied more than 2000 patients colonized with MRSA who were discharged from hospitals in Southern California from 2011 to 2014, as investigators sought to reduce MRSA colonization in patients. Project CLEAR (Changing Lives by Eradicating Antibiotic Resistance) is a joint effort through the University of California Irvine, Los Angeles Biomedical Research Institute at Harbor-UCLA, and Rush University.

The patients being studied were divided into 2 groups—one of which would receive educational material with infection prevention recommendations regarding personal hygiene, laundry, and household cleaning. These tactics sought to reduce information gaps and help prevent post-discharge transmission.

The second group of patients received the same educational materials, but they also took additional steps to reduce colonization and overall bio-burden from their skin and noses, which are common areas of MRSA colonization. For 6 months, this group of patients used chlorhexidine antiseptic for bathing, chlorhexidine mouthwash, and a nasal antimicrobial ointment (mupirocin).

Participants were followed for a year and not surprising, there was a 30% reduction in the group receiving additional treatment instructions. An interesting finding is that these patients they also had a 17% reduction in all infections and individuals who strictly followed the treatment regimen, experienced a 44% reduction in MRSA infections as well as a 40% reduction in all infections. 

The decolonization process and harshness of chlorhexidine products is often a topic of conversation and 2% of those patients in the group did experience mild side effects, while 1% experienced mild side effects related to use of the nasal ointment or mouthwash. Of those who did experience the side effects, 40% opted to continue with the decolonization treatment. 

This study has critical implications in that it found that decolonization efforts including bioburden reduction reduced the burden of MRSA infections for patients post-discharge.

Too often discharge instructions are complex and leave the patient with a poor understanding of their medical needs/outcomes. In my experiences, the concept of colonization versus active infection can be deeply confusing for patients, especially if isolation or decolonization practices are needed.

This study draws attention to the role of post-discharge MRSA infections and how decolonization efforts can help prevent infections, emphasizing that employing these strategies can help prevent MRSA transmission in the community. 
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Big advances in treatment can't make up for an inability to stop new infections, which number 5,000 per day worldwide.
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