A universal decolonization practice in the ICU was more effective at reducing rates of methicillin-resistant Staphylococcus aureus infections than targeted decolonization or screening and isolation practices, researchers reported in The New England Journal of Medicine.
“Patients in the ICU are already very sick, and the last thing they need to deal with is a preventable infection,” Carolyn M. Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ), said in a press release. “This research has the potential to influence clinical practice significantly and create a safer environment where patients can heal without harm.”
Researchers with the CDC Prevention Epicenters Program, AHRQ Developing Evidence to Inform Decisions about Effectiveness (DECIDE) Network and Healthcare-Associated Infections Program conducted the cluster-randomized REDUCE MRSA trial, which included 74,256 patients at 74 ICUs. After a baseline period and phase-in period, there was an 18-month intervention period in which patients were randomly assigned to three groups.
In group 1, all patients were screened for MRSA, and those who were positive had contact precautions. In group 2, patients with known MRSA underwent decolonization. In group 3, there was no MRSA screening and all patients underwent decolonization, plus daily bathing with chlorhexidine cloths during their ICU stay.
The universal decolonization group had a significant reduction in hazard of MRSA-positive clinical cultures (HR=0.63) compared with the targeted decolonization group (HR=0.75) and the screening and isolation group (HR=0.92). For bloodstream infections with any pathogen, there also was a significant hazard reduction for the universal decolonization group (HR=0.56) vs. the targeted decolonization group (HR=0.78) and the screening and isolation group (HR=0.99).
“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,” study researcher Susan Huang, MD, MPH, associate professor at the University of California, Irvine School of Medicine and medical director of epidemiology and infection prevention at UC Irvine Health, said in a press release. “The universal decolonization strategy was the most effective and the easiest to implement. It eliminates the need for screening ICU patients for MRSA.”
Disclosure: The researchers report no relevant financial disclosures.