Infection Control Works Against MRSA
Easily implemented infection control measures in the intensive-care unit can lower bloodstream infections with potentially life-threatening antibiotic-resistant staph germs by as much as 37 percent, according to a new study.
The findings are important, because bloodstream infections, or “bacteremia,” caused by the germs are especially dangerous for hospitalized patients, with a death rate as high as 30 percent.
Researchers looked at the effectiveness of three prevention practices for the resistant germ, methicillin-resistant Staphylococcus aureus, or MRSA, in 74 adult intensive care units in 43 hospitals. More than 74,000 patients were included in the study, making it the largest of its kind.
Infections More Serious in Hospitals
Outside of the hospital, most MRSA infections occur on the skin. But in hospitals, more severe and potentially life-threatening MRSA infections occur in patients’ surgical wounds, urinary tract, bloodstream, or lungs (as pneumonia) — and are more common in more vulnerable patients in the intensive care unit.
“Patients in the ICU are already very sick, and the last thing they need to deal with is a preventable infection,” said Agency for Healthcare Research and Quality Director Carolyn M. Clancy, M.D. “This research has the potential to influence clinical practice significantly and create a safer environment where patients can heal without harm.”
The latest study, called the “REDUCE MRSA” study, took place in two stages from 2009-2011.
Researchers assessed how well three different MRSA prevention practices worked:
- routine care, which included testing patients for MRSA and isolating them from other patients if they had the germ
- using antibacterial-impregnated cloths and antibiotic ointment with patients who had known MRSA (called “targeted decolonization”)
- or providing antibacterial-impregnated cloths and antibacterial ointment to all ICU patients (called “universal decolonization”) without testing them for MRSA
The second and third groups of patients received twice-daily swabbing of their nostrils with an antibiotic ointment for five days. This was done in order to help reduce MRSA contamination of their bodies (decolonization).
If a person is colonized with MRSA or another germ, they may not have an actual infection. However, they are more likely to get an infection from MRSA or pass the germ to someone else. The nose is a common place where people harbor the MRSA germ.
Study Included Daily Baths with Cloths
Patients in the second and third groups also were bathed daily with special cloths containing the antibacterial agent chlorhexidine to help remove MRSA germs from their skin.
The universal method of using antibacterial cloths and ointment in all patients was more effective than the targeted intervention for reducing MRSA in the ICU patients. The universal method lowered MRSA rates by 37 percent and bloodstream infections from any type of germ (not just MRSA) by 44 percent.
Tom Frieden, MD, MPH, director of the Centers for Disease Control, said that “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.”
Most Staph Infections Now Resistant
Three-fourths of all staph infections in hospital ICUs are resistant to methicillin. Infections appear to be waning, with a 2012 CDC report showing that life-threatening MRSA infections in hospitals decreased by 48 percent between 2005-2010.
Susan Huang, MD, MPH, associate professor at the University of California at Irvine School of Medicine, and lead author of the study, said there has been “long-term disagreement within the medical community regarding how to reduce MRSA rates”. Should infection control efforts should be directed at fighting MRSA in patients known to have it, or should they be applied to all patients?
“The universal decolonization strategy was the most effective and the easiest to implement,” she said. “It eliminates the need for screening ICU patients for MRSA.”