Can screening and decontamination procedures performed on an outpatient basis reduce colonization with Staphylococcus aureus and mitigate associated complications in patients undergoing elective hospital procedures? A controlled intervention study (STAUfrei)

Staphylococcus aureus colonization increases the risk of wound infection in surgical procedures. Prevention strategies to date have focused primarily on the hospital setting, although there are recommendations for pre-hospital decontamination at home, which can be performed by patients themselves. This study aimed to shift the process of screening and decontamination of S. aureus [meticillin-resistant S. aureus (MRSA) and meticillin-susceptible S. aureus (MSSA)] out of the hospital setting. Between April 2019 and March 2022, 8054 (intervention group N=3390, control group 4664) patients (age >18 years) undergoing elective procedures in a hospital in Baden-Württemberg (Germany) were recruited for the study. The intervention consisted of 5 days of decontamination carried out by patients (or their caregivers) in their domestic environment. The analysis comprised a simple arm comparison of colonization rates at admission between study groups, as well as adjusted logistic regressions. After adjustment for relevant risk factors, the intervention reduced the risk of S. aureus colonization at admission by 14%; this difference was significant (odds ratio 0.86, 95% confidence interval 0.74–0.10; P=0.046). Re-admission was significantly less common in the intervention group. Signs of wound infection and recolonization after invasive procedures did not differ significantly between the study groups. Outpatient decontamination measures appear to be more effective compared with routine care. As the results from logistic regressions are based on MSSA, its consideration in clinical hygiene management should be discussed. Strict adherence during the coronavirus disease 2019 pandemic was challenging, potentially underestimating the overall impact of the intervention.