Disinfecting all intensive-care patients to remove potentially deadly bacteria can prevent infections better than testing for a superbug and targeting only those who carry it, researchers said.
Patients in hospital intensive-care units are particularly vulnerable, weakened so that normally harmless microbes can make them ill and sensitive to acquiring infections from others. Hospitals in the U.S. typically test for bacteria like methicillin-resistant Staphylococcus aureus when patients are admitted and isolate those who show signs of harboring it to stop the spread.
The approach doesn’t help the carriers, according to research published in the New England Journal of Medicine that shows it also isn’t ideal for preventing more infections. Instead, bathing every patient with anti-microbial soap and using a topical antibiotic ointment for five days to kill reservoirs in the nose reduced infection rates 44 percent, the study found.
“This is the answer to a long-debated question: Do we target every superbug one by one or try to protect a certain patient group from all disease,” Susan Huang, the lead researcher and associate professor in infectious disease at the University of California, Irvine, School of Medicine, said in a telephone interview. “Targeting high-risk patients seems to be the better way to go. Universal decontamination is the easiest and most effective way to prevent infection.”
The research released yesterday involved 74,256 patients at 43 hospitals across the country owned by Nashville, Tennessee-based HCA Holdings Inc., the largest for-profit U.S. hospital chain. The study examined three methods to control hospital-acquired infections, a main cause of preventable illness and death. Reducing infections has become a focus of the U.S. government, which put policies in place to penalize institutions with high infection levels.
The researchers found no benefit in preventing bloodstream infections with the most commonly used approach of testing and isolating patients with MRSA. Testing and treating only those who carried the bacteria was more effective, though not as much as universally treating patients to eradicate all types of microbes, regardless of whether they showed signs of MRSA, the investigators found.
The finding should have immediate implications, Huang said. Each MRSA infection can boost health-care costs by $20,000 as doctors fight the bug and work to stop it from spreading. The universal treatment approach was relatively inexpensive and yielded an unexpectedly dramatic benefit, she said.
“I really believe that this should be adopted by many, if not most hospitals as a way to reduce infections from all pathogens, not just these superbugs,” she said.
HCA has started using the approach at its hospitals, which account for about 5 percent of all inpatient care in the U.S., she said.
The patients were treated with intranasal mupirocin, a generic antibiotic, for five days and bathed with cloths that contained the antimicrobial drug chlorhexidine for their entire stay. The approach would prevent 1 bloodstream infection for every 54 patients who were treated, the researchers calculated. The reduction in MRSA infections was similar to the decrease in all infections, though it wasn’t statistically significant.
The study resolves one of the most controversial issues in infection control for the past decade and should lead to the repeal of laws in nine states requiring MRSA screening, said Michael Edmond and Richard Wenzel from Virginia Commonwealth University School of Medicine’s division of infectious diseases in Richmond.
Patients shouldn’t be isolated, an “unfriendly” practice that can interfere with care, they wrote in an editorial accompanying the study.
The findings should bolster the argument for treating all patients “to control not only the pathogens of today but those of tomorrow as well,” they wrote. They also cautioned against universal use of mupirocin because resistance can develop, making the drug less effective.
Huang agreed that doctors should closely monitor patients to ensure drug resistance doesn’t develop. Since the medicine isn’t currently used to treat active infections, however, she said its use doesn’t have to be limited.
“These agents aren’t used to treat disease,” she said. “These are topical agents to get things off the skin and out of the nose. We haven’t lost an antibiotic we would traditionally use if resistance develops.”
The Agency for Healthcare Research and the U.S. Centers for Disease Control and Prevention funded the study.