Universal ICU Decolonization: An Enhanced Protocol

Appendix C. Universal Decolonization in Adult ICUs Overview Statement

Overview Statement on Strategy to Reduce MRSA Burden and Bloodstream Infection from All Pathogens

What is Universal Decolonization?

Universal decolonization is the routine use of special soaps and nose ointments to reduce bacteria on the body during periods of high risk for infection, such as ICU stays. Risk is high in the ICU because of lines, devices, surgical and nonsurgical wounds, and other reductions in body defenses.

Universal Decolonization consists of:

  • Daily chlorhexidine bathing which replaces soap and water bath.
  • 5 days of nasal mupirocin.

Rationale for Decolonization: The REDUCE MRSA Trial

  • The results of the REDUCE MRSA Trial provide strong evidence in support of universal decolonization to reduce MRSA and other pathogens in adult ICUs.
  • The trial involved 43 hospitals, 74 ICUs, and over 75,000 ICU patients.
  • It resulted in a 44 percent reduction in all-cause bloodstream infections (not just central line infections).
  • It also resulted in a 37 percent reduction in MRSA clinical cultures.

Estimated Benefit from Universal Decolonization

  Current Annual # After Adoption of Universal Decolonization
Annual ICU bloodstream infections AA (AA * (1-0.44))
Annual ICU MRSA clinical cultures BB (AA * (1-0.37))

Cost Effectiveness of Universal Decolonization

Cost saved from bloodstream infections averted (AA * (1-0.44)) * $18,000
Product cost [($CHG cost * ICU patient days) +
(mupirocin cost * ICU LOSa * ICU admissions)]

Intervention savings


a. Or 5 days, whichever is less.

Page last reviewed September 2013
Page originally created September 2013
Internet Citation: Appendix C. Universal Decolonization in Adult ICUs Overview Statement. Content last reviewed September 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/universal_icu_decolonization/universal-icu-apc.html