Decolonization of patients and health care workers to control nosocomial spread of methicillin-resistant Staphylococcus aureus: a simulation study

Background: Control of methicillin-resistant Staphylococcus aureus (MRSA) transmission has been unsuccessful in many hospitals. Recommended control measures include isolation of colonized patients, rather than decolonization of carriage among patients and/or health care workers. Yet, the potential effects of such measures are poorly understood. Methods: We use a stochastic simulation model in which health care workers can transmit MRSA through short-lived hand contamination, or through persistent colonization. Hand hygiene interrupts the first mode, decolonization strategies the latter. We quantified the effectiveness of decolonization of patients and health care workers, relative to patient isolation in settings where MRSA carriage is endemic (rather than sporadic outbreaks in non-endemic settings caused by health care workers). Results: Patient decolonization is the most effective intervention and outperforms patient isolation, even with low decolonization efficacy and when decolonization is not achieved immediately. The potential role of persistently colonized health care workers in MRSA transmission depends on the proportion of persistently colonized health care workers and the likelihood per colonized health care worker to transmit. As stand-alone intervention, universal screening and decolonization of persistently colonized health care workers is generally the least effective intervention, especially in high endemicity settings. When added to patient isolation, such a strategy would have maximum benefits if few health care workers cause a large proportion of the acquisitions. Conclusions: In high-endemicity settings regular screening of health care workers followed by decolonization of MRSA-carriers is unlikely to reduce nosocomial spread of MRSA unless there are few persistently colonized health care workers who are responsible for a large fraction of the MRSA acquisitions by patients. In contrast, decolonization of patients can be very effective.