Study sets standard for responsible infection prevention

Reducing healthcare-associated infections (HAIs) is an important national goal, established in 2008, when the U.S. Department of Health and Human Services (HHS) announced its National Action Plan to Prevent Healthcare Associated Infections.

The goal is complex, but a recent study conducted in HCA facilities is advancing national progress toward eliminating HAIs and providing a safer hospital environment for patients. The ability to go from clinical study to practice relatively quickly was enhanced by the pragmatic nature of the trial, which was incorporated into the daily workflow of hospital clinicians and did not require on-site investigators or research staff.

The comprehensive study, known as Randomized Evaluation of Decolonization versus Universal Clearance to Eliminate (REDUCE) MRSA (Methicillin-resistant Staphylococcus aureus), was conducted exclusively at 43 HCA-affiliated hospitals. It involved nearly 75,000 patients and more than 280,000 patient days in 74 adult Intensive Care Units (ICUs), located in 16 states.

The study concluded that using antimicrobial soap and a nasal ointment on adult ICU patients reduces bloodstream infections, including MRSA, by 44 percent. The results convinced HCA to begin implementing this protocol, called universal decolonization, in its adult ICUs in 2013.

“The REDUCE MRSA study proved convincingly that universal decolonization is the best practice to prevent infection from MRSA and other antibiotic-resistant bacteria in high-risk ICU patients,” said Dr. Jonathan B. Perlin, President, Clinical and Physician Services, and Chief Medical Officer. “By bathing patients daily with chlorhexidine antiseptic soap and swabbing their noses twice daily with mupirocin antibiotic ointment, central line bloodstream infections caused by MRSA and other antibiotic-resistant bacteria can be reduced.”

Dr. Perlin also had praise for the collaborative effort, a national study with strong outcomes that may be easily replicated by other hospitals.

“This unprecedented partnership has yielded information that not only makes preventing MRSA and other antibiotic-resistant bacteria simpler and more effective, it sets a new standard for responsible infection prevention,” he said.

Multidrug-resistant organism (MDRO) is a general term used to describe a number of bacteria resistant to ordinary antibiotics, making them significantly harder to treat. Eradicating MRSA, an MDRO, is a goal that was being championed by Dr. Perlin even before the HHS launched its national initiative.

HCA’s prevention protocols

Shortly after arriving at HCA, Dr. Perlin challenged clinicians to find new ways to effectively combat problems associated with MRSA by identifying high-risk patients and making sure their infection risk was being properly managed and treated at all facilities, said Jason Hickok, MBA, RN, Assistant Vice President of the Critical Care, Infection Prevention and Lab Programs for the Clinical and Physician Services Group.

One resulting program was MRSA ABCs, which uses letters of the alphabet as reminders, to summarize HCA’s MRSA-prevention steps:

  • Active surveillance. If admitted patients are high risk, a nasal swab is collected to determine if they are positive for MRSA.
  • Barrier precautions. If the nursing staff knows a patient is colonized or infected with MRSA, they take appropriate measures (gowns and gloves) to avoid transmitting the bacteria from one patient to the next.
  • Compulsive hand hygiene. Proper hand washing and sanitization reduces transmission of organisms.
  • Disinfection. Once there’s a known colonization, the room is thoroughly cleaned once the patient has been removed.
  • Executive ownership. Every hospital CEO is responsible for implementation of the MRSA-elimination protocols.
  • “Dr. Perlin’s vision of the MRSA ABCs was transformed into a clinical program for HCA hospitals,” Hickok said. “After seeing significant reduction in MRSA infections, we began sharing our results nationally at professional conferences.”

Soon the CDC and Harvard approached HCA to partner on the REDUCE MRSA study, which benefited from data-gathering efficiencies HCA brought to the partnership.

“We were able to offer study planners the ability to use a common platform for collecting data due to the fact we have a standard documentation system in our all of our hospitals,” Hickok said.

There are costs involved in the new protocol, but the improved patient care is well worth the added expense.
“We are making a serious investment based on the clinical results of the trial and believe strongly in this protocol,” Hickok said.

REDUCE MRSA – Study Partners

  • Centers for Disease Control
  • CDC Prevention Epicenter Program,
  • University of California, Irvine
  • Harvard Pilgrim Health Care Institute
  • Harvard Medical School
  • Rush University
  • Washington University, St. Louis
  • Agency for Healthcare Research & Quality’s Healthcare Associated Infections Program
  • AHRQ’s Developing Evidence to
  • Inform Decisions about Effectiveness
  • (DECIDE) Network