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Hospital Corporation of America hospitals throw a punch at MRSA

Monday January 14, 2013
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A comprehensive study conducted at 43 Hospital Corporation of America hospitals in 16 states, including Florida, recently concluded that daily bathing of all ICU patients with antimicrobial soap, and use of a nasal antibicrobial ointment, reduced bloodstream infections, including MRSA, by 44%.

The landmark study will translate into best practices for ICUs across the country, said Dawn Carroll, RN, MBA, MSW, BSN, SICU director at Regional Medical Center Bayonet Point, Hudson, Fla.

"I’ve been a nurse for 22 years, from New York to California, and MRSA is huge everywhere," she said. "This is a breakthrough. We’re excited to be part of the study that sets a new standard for prevention."

The study, known as the Randomized Evaluation of Decolonization versus Universal Clearance to Eliminate MRSA in ICUs (REDUCE MRSA) was conducted in collaboration with Harvard Medical School/Harvard Pilgrim Healthcare Institute in Boston; the University of California, Irvine; the U.S. Agency for Healthcare Research and Quality; and the Centers for Disease Control and Prevention.

The impact on the ICU patient population will be substantial, said Michele DeWalt, RN, CIC, LHCRM, infection control preventionist, Medical Center of Trinity (Fla.). "It’s going to mean less infections, the length of stay will be shortened, patients will get well faster," she said. "Patients are thrilled to pieces we’re being proactive on this."

The study has already drawn interest from several other hospital systems and government health agencies, said Jason Hickok, RN, MBA, one of the study’s authors and assistant vice president of critical care and infection prevention for HCA in Nashville, Tenn.

"Based on this landmark study, we expect many ICUs to follow this best practice," he said. "In addition, the CDC is reviewing its guidance in light of this study."

The 2009-11 study, which involved more than 74,000 patients and more than 280,000 patient days in 74 adult ICUs, compared the results of three approaches in ICUs:

• Screening all patients and isolating MRSA carriers

• Targeted decolonization after screening

• Universal decolonization — the use of antimicrobial agents on an entire patient population

All three arms of the study had been researched in smaller observational trials to reduce MRSA, but there has not been a robust head-to-head trial looking at which approach is the most effective, until the REDUCE MRSA study, Hickok said.

The procedure included bathing patients daily with chlorhexidine antiseptic soap wipes and nasal swabbing with mupirocin antibiotic ointment, said DeWalt.

"The procedures also help with other infections," Carroll said. "Bloodstream infection rates will go down."

The soap wipes provide 24-hour protection against infection and do not irritate the skin, she said. The ointment requires a doctor’s prescription, she added.

Investigators found that universal decolonization reduced the number of patients harboring MRSA by 37%. MRSA carriers may not have acute infections from the bacteria, but they can spread it to others and are at risk for later illness.

All HCA hospitals expect to implement the new decolonization procedure this year.

New policies based on the study results are restricted for just the ICU because it is such a high-risk area for infection, DeWitt said.

"The practice will move to other areas of the hospital only if we get a scientific, evidence-based study to back it," she said.

The study concept and design was created by investigators in the CDC’s Prevention Epicenter Program. AHRQ’s Healthcare Associated Infections program provided funding, and the research was conducted through AHRQ’s DECIDE (Developing Evidence to Inform Decisions about Effectiveness) network.


Teresa McUsic is a freelance writer. Post a comment below or email editorSouth@nurse.com.