Soap, ointment for all ICU patients best for fighting MRSA

by | May 31, 2013

Using ointment and germ-killing soap on all intensive-care unit patients proved more effective than screening patients in reducing bloodstream infections and lowering the presence of methicillin-resistant Staphylococcus aureus, or MRSA, according to a study published Wednesday in the New England Journal of Medicine.

In the large study, a team of researchers from the University of California, Irvine, Harvard Pilgrim Healthcare Care Institute, HCA and the Centers for Disease Control and Prevention examined the results of three MRSA-prevention practices, including routine care that involves detecting MRSA and isolating it; providing the ointment called intranasal mupirocin and cholorhexidine, a germ-killing soap, to those patients with MRSA; and providing the ointment and soap to all patients in the ICU. According to the study, the last strategy—known as “universal decolonization”—proved the most successful of the three and reduced MRSA-positive clinical cultures by 37%. The practice was also effective in preventing infections by germs other than MRSA. Researchers found that this approach reduced bloodstream infections from any pathogen by 44%.

“This study helps answer a long-standing debate in the medical field about whether we should tailor our efforts to prevent infection to specific pathogens, such as MRSA, or whether we should identify a high-risk patient group and give them all special treatment to prevent infection,” Dr. Susan Huang, the study’s lead author and associate professor at the University of California’s Irvine School of Medicine said in a news release about the findings. “The universal decolonization strategy was the most effective and the easiest to implement. It eliminates the need for screening ICU patients for MRSA.”

In an editorial about the study, Drs. Michael Edmond and Richard Wenzel from the division of infectious diseases at Virginia Commonwealth University’s internal medicine department, wrote that the implications of the study are highly important and go beyond MRSA.

“The lack of effectiveness of active detection and isolation should prompt hospitals to discontinue the practice for control of endemic MRSA,” the physicians wrote. “A benefit will be a reduced proportion of patients requiring contact precautions, which is a patient-unfriendly practice that interferes with care,” they continued, adding that pursuing laws mandating MRSA screening should be repealed.

The study, called the REDUCE MRSA trial, included 74,256 patients at 74 adult ICUs in two phases between 2009 and 2011. It was funded by the Agency for Healthcare Research and Quality and the CDC.

From: Modern Healthcare

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