Authors (including presenting author) :
Cham E, Ng ML, Poon ST, Siu MK, Tse NL, Ho KM All members of Infection Control Team of Intensive Care Unit, Prince of Wales Hospital
Affiliation :
Intensive Care Unit, Prince of Wales Hospital
Keyword 1: :
Methicillin-Resistant Staphylococcus Aureus
Keyword 3: :
hospital-acquired infection
Keyword 4: :
Intensive care unit
Introduction :
Methicillin-Resistant Staphylococcus aureus (MRSA) is one of the leading causative organisms in common hospital-acquired infections (HAIs). It poses a significant threat to intensive care unit (ICU) patients due to their increased susceptibility, frequent invasive procedures and high antibiotic usage. Preventive infection control measures to limit its spread are critically important. Previously, most efforts focused on routine MRSA surveillance and contact precautions after a positive culture, with less emphasis on reducing bacterial load. Hence with reference to the hospital MRSA decolonization program, our unit adopted an “Universal MRSA Decolonization Program”, extending the interventions to all ICU patients, aimed at reducing the incidence of HAIs and improving patient outcomes.
Objectives :
The project aims to evaluate the impact of a universal MRSA decolonization protocol on the incidence of hospital-acquired MRSA infections in an intensive care unit (ICU).
Methodology :
A structured universal decolonization program was implemented in our Prince of Wales Hospital ICU on August 27, 2024. This enhanced, comprehensive program builds upon the unit's previous MRSA prevention measures. The program highlighted: (1) admission MRSA screening, (2) daily 2% chlorhexidine gluconate (CHG) bathing, (3) daily linen/clothing changes, and (4) 5-day mupirocin nasal ointment for all ICU patients (exclusions: hypersensitivity, skin erosion, or under Candida auris screening). MRSA and multidrug-resistant organisms (MDROs) rates were monitored quarterly.
Result & Outcome :
Following the implementation of the universal decolonization program, hospital-acquired MRSA infections (confirmed by clinical specimens) declined from a pre-intervention quarterly peak of 3 cases in the fourth quarter (Q4) of 2023 to 0 cases in 2024; this zero incidence was sustained until the third quarter (Q3) of 2025. Similarly, screening-detected hospital-acquired MRSA cases dropped from a pre-intervention high of 6 cases per quarter (Q2–Q3 2023) to 0 cases by Q4 2024 and maintained a zero case count through Q3 2025. Concurrently, no hospital-acquired Carbapenem-Resistant Acinetobacter (CRA) was detected post-intervention (from Q4 2024 to Q3 2025), compared to pre-intervention peaks of 1–2 cases per quarter in 2023. For Multi-Drug Resistant Acinetobacter (MDRA), the yearly incidence of hospital-acquired infections was reduced from 2 cases in both 2022 and 2023 to zero in 2024, with only 1 case reported up to Q3 2025.
