Abstracts from the 8th International Congress of the Asia Pacific Society of Infection Control (APSIC)

Abstract

Background Methicillin-resistant Staphylococcus aureus (MRSA) is a growing clinical problem in intermediate-care facilities. Nasal carriage could be a source of nosocomial transmission, and decolonization could reduce institutional MRSA prevalence. We evaluated the effect of octenidine nasal gel, coupled with universal chlorhexidine baths, in reducing MRSA prevalence. Materials and methods: We conducted a quasi-experimental before-after study, screening all inpatients for MRSA in a rehabilitation facility in Singapore, in June-2014, July-2015, and July-2016. Nasal, axilla, and groin swabs were cultured on selective chromogenic agar. Universal chlorhexidine baths were implemented in 2014-2015. Octenidine nasal gel for MRSA-colonizers was added in 2016. Multivariable logistic regression models were constructed to assess for differences in MRSA prevalence. Results: A total of 257 patients (97 in 2014, 77 in 2015, 83 in 2016) were screened. MRSA prevalence was 33.0% in 2014, 39.0% in 2015, and 19.3% in 2016 (P = 0.020). Groin colonization decreased from 21.7% (2014) and 28.6% (2015), to 14.5% (2016) (P = 0.094). Nasal colonization decreased from 17.5% (2014) and 21.8% (2015), to 6.0% (2016) (P = 0.020). Median length of stay (LOS) was longer in 2016 (20 days) compared to 2014 (14 days, P = 0.043) and 2015 (13 days, P = 0.012), although age and gender distributions were similar. After adjusting for age, gender, and LOS, MRSA colonization was significantly higher in 2014 (OR 2.69, 95%CI 1.23-5.89) and 2015 (OR 4.00, 95%CI 1.77-9.02) than 2016. Conclusions Topical nasal octenidine, coupled with universal chlorhexidine baths, can reduce MRSA colonization prevalence in intermediate-care facilities. Larger studies should be conducted to validate the findings and assess for applicability in other settings.