How HCA hospitals cut ICU infections by 44%

Universal decolonization strategy beat screening, targeted decolonization

Staff at HCA-affiliated hospitals found that using antimicrobial soap and ointment on all ICU patients reduced bloodstream infections—including methicillin-resistant Staphylococcus aureus (MRSA)—by 44%, according to a study presented last week. 

The HCA-led study—known as the Randomized Evaluation of Decolonization Versus Universal Clearance to Eliminate (REDUCE) MRSA, and presented at last week's IDWeek 2012 conference—was expansive: It involved nearly 75,000 adult patients at 74 ICUs in 43 HCA hospitals across 16 states. The study was conducted in conjunction with several academic institutions, including Harvard Medical School, and with research programs at HHS, CDC, and the Agency for Healthcare Research and Quality.

From April 2010 to September 2011, each HCA hospital implemented one of three strategies at all of its ICUs:

  • Screening and isolation: Nasal MRSA screenings, following with isolation when possible.
  • Targeted decolonization: Screening, followed by isolation and decolonization with chlorhexidine baths and mupirocin for five days.
  • Universal decolonization: Universally use mupirocin for five days and daily chlorhexidine baths for the full ICU stay, with no screening.

HCA researchers found that universal decolonization produced far better results than either of the two other strategies. Specifically, universal decolonization:

  • Reduced the number of patients harboring MRSA by 37%; and
  • Reduced all bloodstream infections by 44%.

"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 the chief medical officer of HCA Jonathan Perlin. The universal decolonization method is slated for implementation at virtually all HCA affiliates in early 2013.

Researchers note that the study was primarily conducted at community hospitals by regular hospital personal, not specially trained researchers, meaning the results likely are applicable to nearly all U.S. hospitals (Infection Control Today, 10/23; HCA study, 10/19).

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