Introduction to the Protocol
The Universal ICU Decolonization protocol combines a comprehensive implementation readiness assessment with scientific rationale and training tools for implementation of a universal decolonization strategy to reduce Methicillin-Resistant Staphylococcus aureus (MRSA) and bloodstream infections in adult intensive care units (ICUs). It is intended for use by acute care hospitals that serve critically ill adults in dedicated ICUs. This enhanced protocol provides a scientific foundation for hospital leaders of critical care and infection prevention programs to assess the value of and need for this intervention in their hospital for decisionmaking purposes. It also provides materials and steps for implementation.
Created for clinicians by clinicians, the protocol is designed to serve as a roadmap for hospital champions of this intervention and front-line staff. The initial portion of the protocol is intended to provide the necessary information and decisionmaking tools required to perform an evidence-based assessment of the readiness for adoption. Once the decision has been made to implement universal ICU decolonization, the protocol will provide front-line staff with teaching tools and resources to support change at the unit level. Information is presented in the form of a step-by-step guide that includes the decolonization protocol, a training module, visual aids and skills assessment, and answers to frequently asked questions (Refer to Appendixes A through G).
The protocol assumes existing infrastructure for quality improvement (QI) by which QI and patient safety interventions usually occur. It is well-suited for acute care hospital leaders in QI seeking a practical, evidence-based strategy to improve care, lower adult ICU infection rates, and reduce multi-drug resistant pathogens.
Purpose of the Protocol
This enhanced protocol does the following:
- Provides decisionmaking tools and a rationale to help hospital leaders understand the effectiveness of ICU decolonization with mupirocin and chlorhexidine gluconate (CHG) and determine whether this strategy represents the best course of action for their facility.
- Provides directions on how to garner institutional support from key stakeholders to support the adoption of a universal ICU decolonization strategy within adult units.
- Describes the roles of unit-based physician and nursing champions who oversee the decolonization intervention and provide protocol and educational/training materials for front-line staff.
- Provides tools to assess adherence to the decolonization protocol and reinforce training.
The protocol does not:
- Provide directions for building a comprehensive QI program.
- Address construction of basic infrastructure needs that underlie all improvement campaigns.
- Aim to be appropriate for all hospitals. Hospital-based assessment and decisionmaking are necessary components of the implementation process.
- Provide information on decolonization for children. Pediatric studies and special considerations for pediatric and neonatal ICUs are not addressed here.