Soap, Swabs Slash Infection Rates by 44%

A study conducted at 43 HCA-affiliated community hospitals saw bloodstream infections, including methicillin-resistant Staphylococcus aureus (MRSA), drop by 44% when all ICU patients were subjected to daily "universal decolonization" using antimicrobial soap and nasal swabs.

"The magnitude of this trial is such that it will create a standard of care for most ICUs in the U.S.," study coauthor Ed Septimus, MD, told HealthLeaders Media. "Obviously once this study results are well known we do expect a rapid adoption across most hospitals in the United States."

The study, Randomized Evaluation of Decolonization Versus Universal Clearance to Eliminate MRSA, was conducted with investigators from Harvard and other academic institutions, the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention.

Nearly 75,000 patients and more than 280,000 patient days in 74 adult ICUs in 16 states were involved. Investigators compared three infection control approaches in ICUs:

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

Universal decolonization proved to be the most effective. Patients were bathed daily using chlorhexidine antiseptic soap and their noses were swabbed twice daily with mupirocin antibiotic ointment.

The process reduced the number of patients harboring MRSA by 37% and all bloodstream infections decreased by 44%, says Septimus, who is also HCA's medical director of infection prevention and epidemiology.

The REDUCE MRSA study was released this week at IDWeek 2012, the annual meeting of infectious disease organizations.

Septimus says universal decolonization will be implemented at nearly all HCA-affiliated adult ICUs in early 2013, and that further studies planned for next year may encourage universal decolonization for all hospital in-patients.

He noted that the study involved mostly HCA community hospitals rather than academic institutions using hospital staff instead of specially trained researchers.

"We wanted to test this is a real-world situation. Most studies are done in academic medical centers with very tight inclusion and exclusion criteria," he says, adding that similar results would likely be applicable in nearly every hospital.

Septimus offered several reasons for why universal decolonization is not more widely used now.

"First, its effectiveness hadn't been proven before this study. Secondly there can be local side effects from applying the antibiotic solution, although those were very unusual. Third, we are monitoring this to make sure the bacteria don't develop resistance to the bathing," he says.

"There is a downside to the overexposure. We have to make sure that we do no harm long term. Right now in terms of the risk/benefit ratio the benefit to the patient has been overwhelming and the risk appears to be very small," he says.