Octenidine Body Wash and Nasal Gel Reduces MRSA Bacteremia

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in Singapore hospitals. The Ministry of Health (MOH) has set a reduction of MRSA bacteremia as a key performance indicator for publicly funded hospitals, resulting in the adoption of various strategies to achieve this goal. Decolonization regimens have been implemented in different institutions with variable outcomes. In Tan Tock Seng hospital (TTSH), octenidine was chosen instead of chlorhexidine for its gentler action on the skin, and nasal octenidine was chosen instead of mupirocin (which has a high resistance rate) for nasal decolonization. Methods: All patients admitted to TTSH are screened for MRSA on admission. Patients who are either colonized or infected with MRSA are either placed in isolation rooms (when available) or are placed in cohorts in MRSA wards. The Department of Infection Prevention and Control (IPC) keeps a database of all patients with positive cultures for MRSA, including bacteremia. We used this database to implement and evaluate targeted strategies in such MRSA wards. In January 2018 we began a pilot project in 1 ward, whereby all patients had intranasal octenidine gel applied twice a day for 5 days, as well as daily octenisan baths throughout their stay in the ward. The outcome of interest was MRSA bacteremia occurring ≥3 days after admission. This quasi-experimental before-and-after study was conducted from January 2016 to September 2019 with January 2018 excluded as a washout month. Results: In total, 44 observational months (24 months before the intervention 20 months after the intervention) and 4,309 patients were included. In the preintervention period, 12 bacteremia cases occurred among 2,333 patients (0.5%); in the postintervention period, 4 MRSA bacteremia cases occurred in 1,976 patients (0.2%): RR, 0.49 (95% CI, 0.13–1.22), 1-sided P = .07. The rate of MRSA bacteremia was halved, but it did not reach statistical significance due to the small number of cases overall. The products were well tolerated by patients and staff who applied them to nonambulant patients. Conclusions: Octenidine baths and nasal gel reduced risk of MRSA bacteremia in a cohort of MRSA-positive patients, and this strategy may be preferable to the universal use of antiseptic baths.

Funding: None

Disclosures: None