Rates of invasive methicillin-resistant Staphylococcus aureus (MRSA) infection are highest six months after hospital discharge and remain high for one year. A multicenter, randomized controlled trial compared the effect of hygiene education with education plus decolonization on the likelihood of postdischarge infection in patients colonized with MRSA.

The education group received education on MRSA and advice about personal hygiene, laundry, and household cleaning. Those randomized to decolonization received the same education but also underwent decolonization for five days twice a month for six months. Decolonization involved the use of chlorhexidine for daily bathing or showering, chlorhexidine mouthwash, and nasal mupirocin.

Both per-protocol and as-treated (based on adherence) analyses were performed. In the per-protocol analysis, the primary outcome of MRSA infection (as defined by Centers for Disease Control and Prevention criteria) occurred in 98 of the 1,063 participants (9.2%) in the education group compared with 67 of the 1,058 participants (6.3%) in the decolonization group; 84.8% of infections led to hospitalization. Findings were similar when MRSA was diagnosed by clinical judgment: infection from any cause occurred in 23.7% of participants in the education group compared with 19.6% in the decolonization group; 85.8% of infections led to hospitalization.

In the as-treated analyses, participants in the decolonization group who were fully adherent had 44% fewer MRSA infections and 40% fewer infections from any cause compared with those in the education group.

The authors note that the intervention was not blinded, there was substantial attrition, adherence was self-reported and thus might not reflect actual use, and milder infections may have escaped detection.

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