To cut ICU superbugs, disinfect all patients
WASHINGTON U.- ST. LOUIS (US) — Bathing all patients daily with a germ-killing soap and swabbing antibiotic ointment in their noses may be the best way to reduce the spread of deadly infections, including MRSA.
In a new study, these measures reduced the bloodstream infections caused by dangerous pathogens, including the drug-resistant bacteria MRSA, by 44 percent.
Hospital intensive care units must be continually on guard to prevent infections because they can spread quickly, putting the sickest patients at the most risk. While vigilant hand-washing among hospital staff is critical, many infections also occur from bacteria in patients’ noses and on their skin.
“The results of this study are very important,” says Victoria Fraser, professor of medicine at Washington University in St. Louis. “The risks of acquiring health-care associated infections and multidrug resistant organisms among critically ill patients remain a significant challenge. This study demonstrates new and cost-effective methods to protect patients and improve outcomes in ICUs.”
MRSA is resistant to first-line antibiotic treatments and is a significant cause of illness and sometimes death, especially among patients receiving medical care. In hospital ICUs, 75 percent of MRSA infections are considered resistant to commonly used antibiotics.
Of the strategies tested for reducing MRSA infections, the one that proved most effective was arguably the simplest and most straightforward.
Rather than screening patients in intensive care units for MRSA and isolating or treating only the carriers, all ICU patients were bathed daily using a soap treated with an antiseptic (chlorhexidine), and all received an antibiotic ointment (mupirocin) applied in the nose for five days.
At Barnes-Jewish Hospital, which was not part of the study, all ICU patients already are bathed daily with the chlorhexidine soap. That routine practice was implemented in 2009 after a study by Fraser showed that the antiseptic soap reduced hospital-associated infections by 25 percent among patients in the medical and surgical ICUs at Barnes-Jewish.
Mupirocin ointment is not used routinely in Barnes-Jewish ICUs or in most other hospital ICUs. There are a small number of bacteria that are already resistant to the antibiotic in the ointment and some concerns about whether broad use of mupirocin in ICUs could speed antibiotic resistance.
“Based on the new data, we’ll evaluate whether to incorporate mupirocin into routine use in our ICUs,” says David Warren, medical director for infection prevention. “If we use the ointment, we will closely monitor for antibiotic resistance.”
In ICUs, antibiotic-resistant bacteria that usually live harmlessly on the body cause many infections. These infections can cause serious complications for patients, increasing the duration of their hospital stays, driving up costs, and raising the risk of death. To address the problem, some states have mandated MRSA screening by hospitals, but experts in the field have questioned whether other measures would be more effective.
As part of the study, published in the New England Journal of Medicine, 75,000 patients at 43 hospitals were randomly assigned to one of three approaches for reducing MRSA infections. Patients in the first group were screened for MRSA and isolated if they were found to be carrying the bacteria.
Those in the second group were similarly screened and carriers were isolated, but they also were bathed daily with chlorhexidine soap and received nasal mupirocin ointment for five days to help remove MRSA from the body. All ICU patients in the third group, regardless of whether they harbored MRSA on their bodies, received daily chlorhexidine baths and five days of mupirocin.
The third strategy, known as universal decolonization, was the most effective and the easiest to implement; it also eliminates the need for screening ICU patients for MRSA.
“Overall, the results are very encouraging and provocative,” Warren says. “The results potentially could be applied to many critically ill patients in ICUs throughout the country to reduce the incidence of dangerous infections.”