Using antimicrobial soap and ointment on all intensive-care patients significantly cuts dangerous hospital-acquired infections, researchers have found in a study involving 74 intensive care units in 16 states. This simple intervention could save thousands of lives and drastically reduce the cost of treatment.
Following nearly 75,000 patients in 43 community hospitals, researchers identified strategies for “universal decolonization” for methicillin-resistant Staphylococcus aureus (MRSA) that may have widespread applicability to hospitals across the country. The results were published May 29 in the New England Journal of Medicine.
Of the strategies tested, the one that proved to be most effective was the simplest: Rather than screening intensive care unit (ICU) patients for the bacteria and then treating those identified as carriers, hospital staff followed just one proactive approach with patients. All were bathed daily using chlorhexidine soap during their ICU stays, plus each had mupirocin ointment applied inside nasal passages for five days.
Investigators found that the number of patients harboring MRSA dropped by more than a third. Bloodstream infections caused by MRSA and other pathogens decreased by nearly half.
“The trial provides strong evidence that removing bacteria from the skin and nose is highly effective at preventing infection in high-risk intensive-care patients,” said lead researcher Susan Huang. Huang launched the study while she was a researcher in the HMS department of population medicine. She is now an associate professor of infectious disease and medical director of epidemiology and infection prevention at the University of California, Irvine’s School of Medicine.
Senior investigator Richard Platt, HMS professor of population medicine and chair of the Harvard Pilgrim Health Care Institute and the HMS Department of Population Medicine, noted the value of the design of this trial, which was embedded within usual hospital operations.
"This study highlights the potential to develop important insights as part of routine medical care,” Platt said. “The combination of a committed clinical team and sophisticated electronic medical records made these improvements possible."
The trial, which was conducted in 2010-2011, was a collaborative effort involving several academic institutions, the Centers for Disease Control and Prevention (CDC), and Hospital Corporation of America. The study concept and design was created by investigators at Harvard Pilgrim Health Care Institute, the home of CDC’s Eastern Massachusetts Prevention Epicenter Program, and supported by researchers at the University of California, Irvine; Rush University; and Washington University in St. Louis.
Major funding was provided by the federal Agency for Healthcare Research and Quality.
Adapted from a Harvard Pilgrim Health Care Institute news release.
