Disinfecting all ICU patients significantly reduces MRSA

Decolonization of all intensive care unit (ICU) patients with antimicrobial soap and ointment significantly reduces all bloodstream infections, including methicillin-resistant Staphylococcus aureus (MRSA), according to a study published in the New England Journal of Medicine.

“The REDUCE MRSA study proved that universal decolonization is the best practice to prevent infection from MRSA and other dangerous bacteria in high-risk ICU patients,” said Jonathan B. Perlin, MD, president, clinical and physician services group and chief medical officer of Hospital Corporation of America (HCA).  

The study, the Randomized Evaluation of Decolonization Versus Universal Clearance to Eliminate (REDUCE) MRSA, was conducted at 43 HCA hospitals by academic investigators (the University of California Irvine School of Medicine, Harvard Medical School, Rush Medical College, Washington University in St. Louis), the Centers for Disease Control and Prevention, and the Agency for Healthcare Research and Quality. It involved nearly 75,000 patients in 74 adult ICUs across 16 states.

The study compared screening all patients and isolating MRSA carriers; targeted decolonization (screening, isolation, and decolonization of MRSA carriers with daily bathing with chlorhexidine and administration of intranasal mupirocin ointment twice daily for 5 days); and universally disinfecting all patients with chlorhexidine and mupirocin.

It found universal decolonization reduced MRSA infections by 37%. Targeted decolonization reduced MRSA infections by 25%; and the screening and isolation method reduced MRSA infections by 8%. Universal decolonization reduced all bloodstream infections by 44%.

The study results suggest the need for a major strategy shift in battling MRSA infections, away from targeted to universal decolonization. “Universal decolonization should be a new part of a comprehensive infection prevention effort that begins with hand hygiene and includes a number of proven practices,” Perlin said.