The New England Journal of Medicine has published an infection prevention study conducted exclusively at 43 hospitals affiliated with Hospital Corporation of America (HCA).
The study, known as “Randomized Evaluation of Decolonization Versus Universal Clearance to Eliminate (REDUCE) MRSA,” found using antimicrobial soap and ointment to decolonize all intensive care unit patients reduces all bloodstream infections, including MRSA by 44 percent.
“The REDUCE MRSA study proved that universal decolonization is the best practice to prevent infection from MRSA and other dangerous bacteria in high risk ICU patients,” Jonathan B. Perlin, MD, President, Clinical and Physician Services Group and Chief Medical Officer of HCA, said in a press release. “These compelling results convinced us to implement this protocol in HCA hospital adult ICUs. Universal decolonization should be a new part of a comprehensive infection prevention effort that begins with hand hygiene and includes a number of proven practices.”
The study, which involved nearly 75,000 patients and more than 280,000 days in 74 adult ICUs located in 16 states, compared the results of three approaches:
• Screen all patients and isolate MRSA carriers
• Targeted decolonization: screening, isolation, and decolonization of MRSA carriers with chlorhexidine and mupirocin ointment
• Universal decolonization: no screening and all patients decolonized with chlorhexidine and nasal mupirocin ointment.
The research team found using universal decolonization reduced MRSA clinical cultures by 37 percent. Patients colonized with MRSA may not be sick, but they are at risk for later illness and for spreading it to others. All bloodstream infections were decreased by 44 percent.
The study was conducted in conjunction with investigators at Harvard and several other academic institutions, as well as 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 researchers note 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, they say, these results are likely to be applicable to nearly all U.S. hospitals.
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