Determining the Value of Screening and Decolonization in Burn Unit Management

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is consistently associated with more severe wound complications and worse outcomes in burn patients. Many burn centers who have implemented routine MRSA screening and decolonization protocols have reported reduced MRSA transmission, lower rates of device-associated infections such as CAUTI and CLABSI, and decreased LOS. At the Ohio State University, Wexner Medical Center (OSUWMC), we initiated a multidisciplinary quality improvement two-phase project to implement routine screening. Phase 1: all patients who screened positive for MRSA received a decolonization protocol consisting of intranasal mupirocin twice daily for 5 days and daily chlorhexidine gluconate baths; Phase 2: all patients were screened but no decolonization measures were taken. We aimed to determine if MRSA decolonization aids in decreasing incidence of MRSA, LOS, and incidence of wound infections. Phase 1: 45 patients were admitted in March 2025, with 93% compliance for admission MRSA screening (n = 36). 19 (49%) were negative, 10 (26%) were MSSA+, and 7 (18%) were MRSA+. All MRSA+ patients completed the decolonization protocol. Only 2 of the 45 patients (4%) developed MRSA wound infections requiring treatment. Phase 2: 103 patients from July–September 2025, with a 52.4% compliance rate for screening on admission (n = 54). 36 (66.7%) were negative, 5 (9.3%) were MRSA+, and 13 (24.1%) were MSSA+. 13 patients developed non-MRSA wound infections. No differences in length of stay, LOS/TBSA, incidence of infection by screened result or TBSA (once adjusted) or mortality were observed in either phase. The additional cost and resource utilization required for screening and decolonization did not appear to provide meaningful clinical advantage.