Targeted versus Universal Decolonization to Prevent ICU Infection — NEJM
MRSA Study Results | Agency for Healthcare Research & Quality (AHRQ)
MRSA Study Slashes Deadly Infections in Sickest Hospital Patients
Preventing the spread of antibiotic-resistant infections is a major patient safety challenge for hospitals across the United States. One such infection, methicillin-resistant Staphylococcus aureus (MRSA), is a growing cause of illness and even death, especially among patients in hospitals and nursing homes. Three-quarters of all Staphylococcus aureus infections in hospital intensive care units (ICUs) are considered methicillin-resistant. However, a new study funded by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC) shows that using germ-killing soap (chlorhexidine) and ointment (mupirocin) on all patients admitted to the ICU can reduce all-cause bloodstream infections by up to 44 percent and MRSA clinical cultures by 37 percent. Study findings were published online May 29 in the New England Journal of Medicine. “Patients in the ICU are already very sick, and the last thing they need to deal with is a preventable infection,” said AHRQ Director Carolyn M. Clancy, M.D. “This research has the potential to influence clinical practice significantly and create a safer environment where patients can heal without harm.” The study, known as the REDUCE MRSA trial, involved more than 74,000 patients in 74 ICUs and was conducted in partnership with the Hospital Corporation of America (HCA) by researchers from the University of California, Irvine; Harvard Pilgrim Health Care Institute; and the CDC. The research was conducted in HCA hospitals from 2009 through 2011. Researchers evaluated the effectiveness of three MRSA prevention practices: following 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 third prevention practice, decolonizing all patients who enter the ICU (universal decolonization), was found to be the most effective. Select to read the press release.
MRSA Study Results
MRSA Study Slashes Deadly Infections in Sickest Hospital PatientsPress Release Date: May 29, 2013 Bloodstream infections cut by more than 40 percent in study of over 74,000 patients
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) in ICUs. A new U.S. Department of Health and Human Services-funded study released today tested three MRSA prevention strategies and found that using germ-killing soap and ointment on all ICU patients was more effective than other strategies.
"Patients in the ICU are already very sick, and the last thing they need to deal with is a preventable infection," said Agency for Healthcare Research and Quality (AHRQ) Director Carolyn M. Clancy, M.D. "This research has the potential to influence clinical practice significantly and create a safer environment where patients can heal without harm."
The study, REDUCE MRSA trial , was published in today's New England Journal of Medicine and took place in two stages from 2009-2011. A multidisciplinary team from the University of California, Irvine , Harvard Pilgrim Health Care Institute , Hospital Corporation of America (HCA) and the Centers for Disease Control and Prevention (CDC) carried out the study. A total of 74 adult ICUs and 74,256 patients were part of the study, making it the largest study on this topic. 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. In addition to being effective at stopping the spread of MRSA in ICUs, the study found the use of germ-killing soap and ointment on all ICU patients was also effective for preventing infections caused by germs other than MRSA.
"CDC invested in these advances in order to protect patients from deadly drug-resistant infections," said CDC Director Tom Frieden, M.D., M.P.H. "We need to turn science into practical action for clinicians and hospitals. CDC is working to determine how the findings should inform CDC infection prevention recommendations."
MRSA is resistant to first-line antibiotic treatments and is an important cause of illness and sometimes death, especially among patients who have had medical care. Three-quarters of Staphylococcus aureus infections in hospital ICUs are considered methicillin-resistant. In 2012, encouraging results from a CDC report [PDF File; Plugin Software Help] showed that life-threatening MRSA infections in hospitals declined by 48 percent from 2005 through 2010.
"This study helps answer a long-standing debate in the medical field about whether we should tailor our efforts to prevent infection to specific pathogens, such as MRSA, or whether we should identify a high-risk patient group and give them all special treatment to prevent infection," said lead study author Susan Huang, M.D., M.P.H., associate professor at the University of California, Irvine, School of Medicine and medical director of epidemiology and infection prevention at UC Irvine Health. "The universal decolonization strategy was the most effective and the easiest to implement. It eliminates the need for screening ICU patients for MRSA."
The REDUCE MRSA trial was conducted through AHRQ and CDC research programs. The research was conducted in partnership with the HCA and nearly four dozen of its affiliated facilities.
Reducing healthcare-associated infections (HAIs), such as MRSA, is a priority for the National Quality Strategy, a plan that aligns national efforts to improve the quality and safety of care. HHS-wide efforts to reduce HAIs are outlined in its National Action Plan to Prevent Healthcare-Associated Infections: Roadmap to Elimination.
HAIs are also an area of focus for the Partnership for Patients, a national, public-private partnership of hospitals, employers, physicians, nurses, consumers, state and federal governments and other key stakeholders that aims to reduce preventable hospital-acquired conditions that harm patients. Together, with incentives created by the Affordable Care Act, these efforts represent a coordinated approach to making care safer for patients.
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Current as of May 2013Internet Citation: MRSA Study Results: MRSA Study Slashes Deadly Infections in Sickest Hospital Patients. May 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsroom/press-releases/2013/mrsastudypr.html