Study Shows Universal Decolonization of ICU Patients Reduces Bloodstream Infections by 44 Percent

HCA announces that a comprehensive new study, conducted exclusively at 43 HCA-affiliated hospitals, concluded that using antimicrobial soap and ointment on intensive care unit patients reduces bloodstream infections, including MRSA, by 44 percent.

The use of antimicrobial agents on an entire patient population is referred to as universal decolonization. The study, known as Randomized Evaluation of Decolonization Versus Universal Clearance to Eliminate (REDUCE) MRSA, was conducted in conjunction with investigators at Harvard and several other academic institutions, and research programs at two U.S. Department of Health and Human Services agencies, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC).

The results of REDUCE MRSA were released last week at IDWeek 2012. The findings suggest a major change in healthcare practice that could save lives. HCA is rolling out universal decolonization in its adult intensive care units, and implementation is expected to be completed at virtually all HCA affiliates in early 2013.

The REDUCE MRSA study proved convincingly that universal decolonization is the best practice to prevent infection from MRSA and other antibiotic-resistant bacteria in high risk ICU patients, says Jonathan B. Perlin, MD, president of the Clinical and Physician Services Group and chief medical officer of HCA. By bathing patients with chlorhexidine antiseptic soap and swabbing their noses with mupirocin antibiotic ointment, central line bloodstream infections caused by MRSA and other antibiotic-resistant bacteria can be reduced. These compelling results convinced us to begin implementing this protocol in HCA hospital ICUs.

The study, which involved nearly 75,000 patients and more than 280,000 patient days in 74 adult ICUs located in 16 states, compared the results of three approaches in ICUs:

- Screen all patients and isolate MRSA carriers
- Targeted decolonization after screening
- Universal decolonization

Investigators found that using universal decolonization reduced the number of patients harboring MRSA by 37 percent. Patients harboring MRSA are not sick because of it, but they are at risk for later illness and for spreading it to others. All bloodstream infections decreased by 44 percent. The researchers noted that this trial took place in HCA facilities, mostly in community hospitals, rather than academic institutions and was conducted by hospital personnel rather than specially trained research staff. Therefore, unlike some clinical studies, these results are likely to be applicable to nearly all U.S. hospitals.

REDUCE MRSA was a collaborative effort. The study concept and design was created by investigators in the CDCs Prevention Epicenter Program at the University of California, Irvine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Rush University and Washington University in St. Louis. AHRQs Healthcare Associated Infections program provided funding, and the research was conducted through AHRQs Developing Evidence to Inform Decisions about Effectiveness (DECIDE) network. The research was conducted across 43 HCA hospitals.

This unprecedented partnership has yielded information that not only makes preventing MRSA and other antibiotic-resistant bacteria simpler and more effective, it sets a new standard for responsible infection prevention, says Perlin.