***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Nasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism . Decolonization of nasal and extranasal sites on hospital admission may reduce this risk . METHODS In a r and omized , double-blind , placebo-controlled , multicenter trial , we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction ( PCR ) assay , followed by treatment with mupirocin nasal ointment and chlorhexidine soap , reduces the risk of hospital-associated S. aureus infection . RESULTS From October 2005 through June 2007 , a total of 6771 patients were screened on admission . A total of 1270 nasal swabs from 1251 patients were positive for S. aureus . We enrolled 917 of these patients in the intention-to-treat analysis , of whom 808 ( 88.1 % ) underwent a surgical procedure . All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin . The rate of S. aureus infection was 3.4 % ( 17 of 504 patients ) in the mupirocin-chlorhexidine group , as compared with 7.7 % ( 32 of 413 patients ) in the placebo group ( relative risk of infection , 0.42 ; 95 % confidence interval [ CI ] , 0.23 to 0.75 ) . The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections ( relative risk , 0.21 ; 95 % CI , 0.07 to 0.62 ) . There was no significant difference in all-cause in-hospital mortality between the two groups . The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group ( P=0.005 ) . CONCLUSIONS The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission . ( Current Controlled Trials number , IS RCT N56186788 . BACKGROUND Intensive care units ( ICUs ) are high-risk setting s for the transmission of methicillin-resistant Staphylococcus aureus ( MRSA ) and vancomycin-resistant enterococcus ( VRE ) . METHODS In a cluster-r and omized trial , we evaluated the effect of surveillance for MRSA and VRE colonization and of the exp and ed use of barrier pre caution s ( intervention ) as compared with existing practice ( control ) on the incidence of MRSA or VRE colonization or infection in adult ICUs . Surveillance cultures were obtained from patients in all participating ICUs ; the results were reported only to ICUs assigned to the intervention . In intervention ICUs , patients who were colonized or infected with MRSA or VRE were assigned to care with contact pre caution s ; all the other patients were assigned to care with universal gloving until their discharge or until surveillance cultures obtained at admission were reported to be negative . RESULTS During a 6-month intervention period , there were 5434 admissions to 10 intervention ICUs , and 3705 admissions to 8 control ICUs . Patients who were colonized or infected with MRSA or VRE were assigned to barrier pre caution s more frequently in intervention ICUs than in control ICUs ( a median of 92 % of ICU days with either contact pre caution s or universal gloving [ 51 % with contact pre caution s and 43 % with universal gloving ] in intervention ICUs vs. a median of 38 % of ICU days with contact pre caution s in control ICUs , P<0.001 ) . In intervention ICUs , health care providers used clean gloves , gowns , and h and hygiene less frequently than required for contacts with patients assigned to barrier pre caution s ; when contact pre caution s were specified , gloves were used for a median of 82 % of contacts , gowns for 77 % of contacts , and h and hygiene after 69 % of contacts , and when universal gloving was specified , gloves were used for a median of 72 % of contacts and h and hygiene after 62 % of contacts . The mean ( ±SE ) ICU-level incidence of events of colonization or infection with MRSA or VRE per 1000 patient-days at risk , adjusted for baseline incidence , did not differ significantly between the intervention and control ICUs ( 40.4±3.3 and 35.6±3.7 in the two groups , respectively ; P=0.35 ) . CONCLUSIONS The intervention was not effective in reducing the transmission of MRSA or VRE , although the use of barrier pre caution s by providers was less than what was required . ( Funded by the National Institute of Allergy and Infectious Diseases and others ; STAR*ICU Clinical Trials.gov number , NCT00100386 . ) INTRODUCTION Preoperative nasal mupirocin has been shown to reduce surgical site infections ( SSIs ) in patients undergoing cardiac surgery . We analyzed the effect of mupirocin plus antiseptic body wash on SSI rate and etiology . METHODS Prospect i ve SSI surveillance was done for patients undergoing cardiac surgery before and after implementation of mupirocin nasal ointment and chlorhexidine/octenidine body wash .  RESULTS Overall SSI rate was 8.6 % ( 81 out of 945 ) for the control and 6.9 % ( 58 out of 842 ) for the intervention cohort ( P = .19 ) . In multivariable analysis , the study protocol was associated with an odds ratio of 0.61 ( 95 % confidence interval , 0.41 - 0.91 ; P = .015 ) with regard to any SSI . This effect was exclusively due to a reduction in superficial SSIs and was observed both in patients with preoperative and postoperative treatment initiation . Coagulase-negative staphylococci ( CoNS ) , the most commonly isolated pathogen , were found in 37 % and 48 % ( P = .19 ) of patients in the control and the intervention cohort , respectively . CoNS were methicillin resistant in 69 % of cases . CONCLUSIONS Mupirocin and antiseptic body wash reduced the rate of superficial but not deep or organ/space SSIs . Postoperative patient treatment may be critical in reducing the risk for superficial SSI , presumably due to a reduction of bacterial skin load . A high proportion of SSI was due to methicillin-resistant CoNS and thus not covered by routine perioperative antimicrobial prophylaxis CONTEXT Nosocomial infections are an important cause of morbidity and mortality after cardiac surgery . Decolonization of endogenous potential pathogenic microorganisms is important in the prevention of nosocomial infections . OBJECTIVE To determine the efficacy of perioperative decontamination of the nasopharynx and oropharynx with 0.12 % chlorhexidine gluconate for reduction of nosocomial infection after cardiac surgery . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve , r and omized , double-blind , placebo-controlled clinical trial conducted at the Onze Lieve Vrouwe Gasthuis , Amsterdam , the Netherl and s , between August 1 , 2003 , and September 1 , 2005 . Of 991 patients older than 18 years undergoing elective cardiothoracic surgery during the study interval , 954 were eligible for analysis . INTERVENTION Oropharyngeal rinse and nasal ointment containing either chlorhexidine gluconate or placebo . MAIN OUTCOME MEASURES Incidence of nosocomial infection , in addition to the rate of Staphylococcus aureus nasal carriage and duration of hospital stay . RESULTS The incidence of nosocomial infection in the chlorhexidine gluconate group and placebo group was 19.8 % and 26.2 % , respectively ( absolute risk reduction [ ARR ] , 6.4 % ; 95 % confidence interval [ CI ] , 1.1%-11.7 % ; P = .002 ) . In particular , lower respiratory tract infections and deep surgical site infections were less common in the chlorhexidine gluconate group than in the placebo group ( ARR , 6.5 % ; 95 % CI , 2.3%-10.7 % ; P = .002 ; and 3.2 % ; 95 % CI , 0.9%-5.5 % ; P = .002 , respectively ) . For the prevention of 1 nosocomial infection , 16 patients needed to be treated with chlorhexidine gluconate . A significant reduction of 57.5 % in S aureus nasal carriage was found in the chlorhexidine gluconate group compared with a reduction of 18.1 % in the placebo group ( P<.001 ) . Total hospital stay for patients treated with chlorhexidine gluconate was 9.5 days compared with 10.3 days in the placebo group ( ARR , 0.8 days ; 95 % CI , 0.24 - 1.88 ; P = .04 ) . CONCLUSION Decontamination of the nasopharynx and oropharynx with chlorhexidine gluconate appears to be an effective method to reduce nosocomial infection after cardiac surgery . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00272675 BACKGROUND Both targeted decolonization and universal decolonization of patients in intensive care units ( ICUs ) are c and i date strategies to prevent health care-associated infections , particularly those caused by methicillin-resistant Staphylococcus aureus ( MRSA ) . METHODS We conducted a pragmatic , cluster-r and omized trial . Hospitals were r and omly assigned to one of three strategies , with all adult ICUs in a given hospital assigned to the same strategy . Group 1 implemented MRSA screening and isolation ; group 2 , targeted decolonization ( i.e. , screening , isolation , and decolonization of MRSA carriers ) ; and group 3 , universal decolonization ( i.e. , no screening , and decolonization of all patients ) . Proportional-hazards models were used to assess differences in infection reductions across the study groups , with clustering according to hospital . RESULTS A total of 43 hospitals ( including 74 ICUs and 74,256 patients during the intervention period ) underwent r and omization . In the intervention period versus the baseline period , modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation ( crude rate , 3.2 vs. 3.4 isolates per 1000 days ) , 0.75 for targeted decolonization ( 3.2 vs. 4.3 isolates per 1000 days ) , and 0.63 for universal decolonization ( 2.1 vs. 3.4 isolates per 1000 days ) ( P=0.01 for test of all groups being equal ) . In the intervention versus baseline periods , hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 ( crude rate , 4.1 vs. 4.2 infections per 1000 days ) , 0.78 ( 3.7 vs. 4.8 infections per 1000 days ) , and 0.56 ( 3.6 vs. 6.1 infections per 1000 days ) , respectively ( P<0.001 for test of all groups being equal ) . Universal decolonization result ed in a significantly greater reduction in the rate of all bloodstream infections than either targeted decolonization or screening and isolation . One bloodstream infection was prevented per 54 patients who underwent decolonization . The reductions in rates of MRSA bloodstream infection were similar to those of all bloodstream infections , but the difference was not significant . Adverse events , which occurred in 7 patients , were mild and related to chlorhexidine . CONCLUSIONS In routine ICU practice , universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen . ( Funded by the Agency for Healthcare Research and the Centers for Disease Control and Prevention ; REDUCE MRSA Clinical Trials.gov number , NCT00980980 ) BACKGROUND Surgical site infection has been identified as one of the most important preventable sources of morbidity and mortality associated with medical treatment . The purpose of the present study was to evaluate the feasibility and efficacy of an institutional prescreening program for the preoperative detection and eradication of both methicillin-resistant and methicillin-sensitive Staphylococcus aureus in patients undergoing elective orthopaedic surgery . METHODS Data were collected prospect ively during a single-center study . A universal prescreening program , employing rapid polymerase chain reaction analysis of nasal swabs followed by an eradication protocol of intranasal mupirocin and chlorhexidine showers for identified carriers , was implemented . Surgical site infection rates were calculated and compared with a historical control period immediately preceding the start of the screening program . RESULTS During the study period , 7019 of 7338 patients underwent preoperative screening before elective surgery , for a successful screening rate of 95.7 % . One thous and five hundred 
    Output:
    
RESULTS Decolonization with topical chlorhexidine and intranasal mupirocin result ed in reduction of S aureus SSI and methicillin-resistant S aureus nosocomial infection and eradication of S aureus nasal carriage .
CONCLUSION The results of this review indicate the combination of topical chlorhexidine and intranasal mupirocin is effective in reducing S aureus-associated SSIs