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September 20, 2016

How HCA cut MRSA infections by nearly 40 percent

Daily Briefing

After HCA successfully cut its MRSA infection rate by almost 40 percent, the hospital system has made itself a "testing ground" for further MRSA infection-reduction strategies, Laura Landro writes for the Wall Street Journal.

MRSA in US hospitals

About half of staph bacteria have developed resistance to methicillin antibiotics—leading to the name MRSA, short for "Methicillin-resistant Staphylococcus aureus." According to CDC, 72,444 patients had invasive MRSA infections in 2014, and nearly 9,200 died. But experts caution the tally could underestimate the actual total, given limited surveillance of MRSA infections.

Hospitals have curbed MRSA infection rates with better hygiene, screening, patient isolation, and other best practices. CDC data show that the incidence of health care-associated MRSA fell by 5.36 percent between 2013 and 2014. However, infections contracted outside of health care settings increased slightly over the same time frame.

New efforts

Despite the progress, researchers say more must be done to stop MRSA—and HCA is helping lead the charge. Susan Huang, a researcher who has led several studies on MRSA infection prevention at HCA hospitals, said, "These are preventable infections and we should be able to drive them down to zero."

In one study, called "Reduce MRSA," Huang and colleagues evaluated an approach called "universal decolonization," which involves bathing incoming ICU patients in chlorhexidine soap and administering mupirocin, a nasal antibiotic.

For the study, which drew data from 74 ICUs in 43 HCA hospitals, researchers compared the universal decolonization protocol with two other approaches:

  • Routinely screening all patients and isolating patients who were colonized or had been colonized before; and
  • Incorporating the bathing and nasal ointment regimen into screening and isolation of patients who were infected with or carriers of MRSA.

The researchers found the universal decolonization approach was more effective than the other two methods, particularly in routine care. It reduced MRSA by 37 percent and all bloodstream infections by 44 percent. According to later research, the universal decolonization approach prevented nine additional bloodstream infections for every 1,000 ICU admissions and saved $171,000.

Given the findings, HCA has adopted universal decolonization in all of its ICUs.

There were no increases in antibiotic resistance during the Reduce MRSA study, though follow-up research is in the works, according to HCA CMO Jonathan Perlin. The follow-up study will look at whether an iodine-based nasal antiseptic works as well as the mupirocin, when combined with the bathing regimen, at reducing MRSA.

Another study, requested by CDC and NIH, is currently evaluating the experience of patients outside of the ICU. The so-called Abate study involves about 600,000 patients located in regular medical and surgical units across 50 HCA hospitals. Researchers are comparing standard bathing and showering to antiseptic bathing across all patients, as well as antibiotic nasal ointment for patients who have MRSA on their bodies or have had prior infection.

And in a third study, titled Clear, Huang is analyzing whether hospitals can prevent new or recurrent MRSA infections by giving patients antiseptic regimens when they're discharged. The study is assessing more than 2,000 recently hospitalized patients who tested positive on an MRSA test. Study participants were randomized into two groups: One group was educated about personal hygiene, while the second group received personal hygiene education in addition to a bi-monthly, six-month regimen of nasal antibiotic ointment, antiseptic mouthwash with chlorhexidine, and chlorhexidine for showering or bathing. 

Clear's results—to be presented at a conference next month—are promising, Huang said (Landro, Wall Street Journal, 9/12).

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