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Universal approach best for halting MRSA in ICUs

Thursday May 30, 2013
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Using germ-killing soap and ointment on all ICU patients can reduce bloodstream infections by up to 44% and significantly reduce the presence of methicillin-resistant Staphylococcus aureus in the units, according to a study funded by the Department of Health and Human Services.

The study tested three MRSA prevention strategies and found that universal decolonization was most effective.

"Patients in the ICU are already very sick, and the last thing they need to deal with is a preventable infection," Carolyn M. Clancy, MD, director of the Agency for Healthcare Research and Quality, said in a news release. "This research has the potential to influence clinical practice significantly and create a safer environment where patients can heal without harm."

The trial, results of which were published May 29 on the website of the New England Journal of Medicine, took place in two stages from 2009-11. A multidisciplinary team from the University of California, Irvine, Harvard Pilgrim Health Care Institute, Hospital Corporation of America and the Centers for Disease Control and Prevention carried out the study. A total of 74 adult ICUs and 74,256 patients were included, making it the largest study on this topic, according to the news release.

The researchers evaluated the effectiveness of three MRSA prevention practices: routine care, targeted decolonization (providing germ-killing soap and ointment only to patients with MRSA) and universal decolonization (providing germ-killing soap and ointment to all ICU patients). In addition to being effective at stopping the spread of MRSA in ICUs, universal decolonization was effective at preventing bloodstream infections from other pathogens.

"CDC invested in these advances in order to protect patients from deadly drug-resistant infections," said CDC Director Tom Frieden, MD, MPH. "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 showed that invasive MRSA infections in hospitals declined by 48% 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 Susan Huang, MD, MPH, the study’s lead author, associate professor at the UCI 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.

Read the study: www.nejm.org/doi/full/10.1056/NEJMoa1207290?query=featured_home#t=articleTop.


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