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Soap, Swabs Slash Infection Rates by 44%

A study  conducted at 43 HCA-affiliated community hospitals saw bloodstream infections,  including methicillin-resistant Staphylococcus  aureus (MRSA), drop by  44% when all ICU patients were subjected to daily "universal decolonization"  using antimicrobial soap and nasal swabs.
"The magnitude of this trial is  such that it will create a standard of care for most ICUs in the U.S.,"  study coauthor Ed Septimus, MD, told HealthLeaders Media. "Obviously once  this study results are well known we do expect a rapid adoption across most  hospitals in the United States."
The study, Randomized  Evaluation of Decolonization Versus Universal Clearance to Eliminate MRSA, was conducted with investigators from  Harvard and other academic institutions, the Agency for Healthcare Research and  Quality and the Centers for Disease Control and Prevention.
Nearly 75,000 patients and more than 280,000 patient days in 74 adult ICUs in  16 states were involved. Investigators compared three infection control approaches  in ICUs:

  • Screen all patients and isolate MRSA carriers
  • Targeted decolonization after screening
  • Universal decolonization

Universal decolonization proved to be the most effective. Patients were bathed  daily using chlorhexidine antiseptic soap and their noses were swabbed twice  daily with mupirocin antibiotic ointment.

The process reduced the number of patients harboring MRSA by 37% and all  bloodstream infections decreased by 44%, says Septimus, who is also  HCA's medical director of infection prevention and epidemiology.

The REDUCE MRSA study was released this week at IDWeek 2012, the annual meeting of  infectious disease organizations.

Septimus says universal  decolonization will be implemented at nearly all HCA-affiliated adult ICUs in  early 2013, and that further studies planned for next year may encourage  universal decolonization for all hospital in-patients.

He noted that the study involved mostly HCA  community hospitals rather than academic institutions using hospital staff  instead of specially trained researchers.

"We wanted to test this is a real-world  situation. Most studies are done in academic medical centers with very tight inclusion  and exclusion criteria," he says, adding that similar results would likely be  applicable in nearly every hospital.

Septimus offered several reasons for why universal decolonization is not more  widely used now.

"First, its effectiveness hadn't been proven before this study. Secondly there  can be local side effects from applying the antibiotic solution, although those  were very unusual. Third, we are monitoring this to make sure the bacteria  don't develop resistance to the bathing," he says.

"There is a downside to the overexposure. We have to make sure that we do no  harm long term. Right now in terms of the risk/benefit ratio the benefit to the  patient has been overwhelming and the risk appears to be very small," he says.

Source: Health Leaders Media at http://www.healthleadersmedia.com/page-3/COM-285617/Soap-Swabs-Slash-Infection-Rates-by-44

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