Whole-body decolonisation policies and Staphylococcus aureus bacteraemia rates in acute hospitals in England: a national cross-sectional survey.

Universal whole-body decolonisation was widely implemented during periods of high meticillin-resistant Staphylococcus aureus (MRSA) prevalence and remains in use despite declining rates and variable hospital policies. A national survey of 94 tertiary acute hospitals in England demonstrated substantial heterogeneity in practice: 59.6% of institutions applied universal decolonisation for patients admitted to high-impact or surgical specialties, 7.4% adopted universal decolonisation for all acute admissions, 30.8% used targeted approaches for MRSA-positive patients only, and 2.1% reported no routine use. Across MRSA and total S. aureus bacteraemia, rates (per 100,000 bed-days) did not differ between policy groups. Within the limitations of ecological inference and the evolving MRSA epidemiology, these findings suggest no evidence that universal decolonisation achieves lower S. aureus bacteraemia rates than targeted approaches. The study calls for a re-evaluation of benefits vs risks of universal decolonisation and the inclusion within antimicrobial stewardship frameworks of topical antimicrobials used for whole-body decolonisation.