UPDATED: Maryn Mckenna – who is Flublogia’s resident expert in all things antimicrobial – has just posted a blog post on this important story on her Superbug Blog.
To Prevent MRSA In Hospitals, Don’t Prevent Only MRSA
- By Maryn McKenna
- 05.30.13 10:54 AM
# 7341
HCAIs (Health care associated Infections) or HAIs (Hospital acquired infections) constitute a major threat to life, health, and the cost of medical care in this country, and around the world.
This oft quoted assessment from the CDC on the burden of Hospital Acquired Infections in the United States is from 2010.
A new report from CDC updates previous estimates of healthcare-associated infections. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:
- 32 percent of all healthcare-associated infection are urinary tract infections
- 22 percent are surgical site infections
- 15 percent are pneumonia (lung infections)
- 14 percent are bloodstream infections
Since 2008 the Centers for Medicare & Medicaid Services (CMS) have adopted a `no pay’ rule for `preventable infections’, or medical mistakes associated with hospital stays in order to encourage facilities to improve procedures and patient safety.
The problem is that many people entering hospitals are colonized – but not necessarily infected – with bacteria like MRSA. When hospitalized, invasive procedures (needle sticks, catheterization, PICC lines, etc) can turn a benign colonization into a life threatening infection.
And their bacteria can be transferred to other patients, staff, or visitors as well.
We’ve covered HAIs often in this blog, including:
HPA: Healthcare-Associated Infection (HCAI) Survey
A Barrier To Good Hand Hygiene
Study: Hospital Uniforms And Bacteria
Study: HAIs, Universal Surveillance, & MRSA
Today, a look at a large study -involving 74 adult ICUs and 74,256 patients between 2009-2011 – published yesterday in the NEJM - that compared three HAI prevention strategies for ICU patients.
- MRSA screening and isolation of colonized patients;
- Targeted decolonization (screening, isolation, & 5 day decolonization regimen of MRSA carriers)
- Universal decolonization (decolonization of all patients without screening - ie. twice-daily intranasal mupirocin x 5 days, daily bathing with chlorhexidine-impregnated cloths for the entire stay)
The results showed that bloodstream infections were cut by more than 40% with universal decolonization. The CDC – which was a participant in this study – has the press release below, after which I have a link to the NEJM study itself.
MRSA study: simple steps slash deadly infections in sickest hospital patients
Bloodstream infections cut by more than 40 percent in study of more than 74,000 patients
A new study
on antibiotic-resistant bacteria in hospitals shows that using germ-killing soap and ointment on all intensive-care unit (ICU) patients can reduce bloodstream infections by up to 44 percent and significantly reduce the presence of methicillin-resistant Staphylococcus aureus (MRSA). Patients who have MRSA present on their bodies are at increased risk of developing a MRSA infection and can spread the germ to other patients.
Researchers evaluated the effectiveness of three MRSA prevention practices: routine care, providing germ-killing soap and ointment only to patients with MRSA , and providing germ-killing soap and ointment to all ICU patients. The study found:
- Routine care did not significantly reduce MRSA or bloodstream infections.
- Providing germ-killing soap and ointment only to patients with MRSA reduced bloodstream infections by any germ by 23 percent.
- Providing germ-killing soap and ointment to all ICU patients reduced MRSA by 37 percent and bloodstream infections by any germ by 44 percent.
The study, REDUCE MRSA trial, was published in the New England Journal of Medicine and took place in two stages from 2009-2011. A multidisciplinary team from the University of California, Irvine
You can read the NEJM Editorial on REDUCE MRSA Trial, and the study at the link below.
Targeted versus Universal Decolonization to Prevent ICU Infection
Susan S. Huang, M.D., M.P.H., Edward Septimus, M.D., Ken Kleinman, Sc.D., Julia Moody, M.S., Jason Hickok, M.B.A., R.N., Taliser R. Avery, M.S., Julie Lankiewicz, M.P.H., Adrijana Gombosev, B.S., Leah Terpstra, B.A., Fallon Hartford, M.S., Mary K. Hayden, M.D., John A. Jernigan, M.D., Robert A. Weinstein, M.D., Victoria J. Fraser, M.D., Katherine Haffenreffer, B.S., Eric Cui, B.S., Rebecca E. Kaganov, B.A., Karen Lolans, B.S., Jonathan B. Perlin, M.D., Ph.D., and Richard Platt, M.D. for the CDC Prevention Epicenters Programthe AHRQ DECIDE Network and Healthcare-Associated Infections Program
May 29, 2013DOI: 10.1056/NEJMoa1207290
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 ClinicalTrials.gov number, NCT00980980.)
It is an impressive result, and reduced not only MRSA, but bloodstream infections by any pathogen. It may very well affect the way ICU admissions are handled in the future.
One caveat from the authors was that extensive use of these antimicrobials could eventually lead to bacteria developing resistance to mupirocin and chlorhexidine.
The authors conclude by writing:
In conclusion, we found that universal decolonization prevented infection, obviated the need for surveillance testing, and reduced contact isolation. If this practice is widely implemented, vigilance for emerging resistance will be required.
