Study finds way to reduce hospital blood infections
NASHVILLE, Tenn. — Treating everybody in an intensive-care unit like they’re a carrier of an antibiotics-resistant staph infection is the best way to prevent bloodstream infections, according to results from a study conducted by Hospital Corporation of America.
Bloodstream infections were reduced 44 percent when every patient was bathed with antimicrobial soap and swabbed under the nose with a chemical ointment. The study results, which compared three protocols among 43 HCA hospitals, were published in The New England Journal of Medicine.
The study set a new standard of care, showing that the bathing process called “universal decolonization” worked better than the existing practices of simply isolating carriers or cleaning them with the antimicrobial soap after isolation. An accompanying editorial in the journal called the study “highly important” and said it should prompt hospitals to discontinue isolation practices.
It involved nearly 75,000 patients in 16 states with hospitals randomly selected to test one of the three protocols. Federal health agencies asked HCA to do the study because of its commitment to reduce bloodstream infections and because the scale of its operations allowed for quick results, said Dr. Jonathan B. Perlin, chief medical officer of HCA.
“One bloodstream infection was prevented for every 54 patients treated or decolonized,” said Dr. Jonathan B. Perlin, chief medical officer of HCA.
Although preventable, bloodstream infections result in thousands of deaths each year and billions of dollars in costs to the health care system, according to the U.S. Centers for Disease Control and Prevention.
The problem became prevalent in hospitals before efforts in recent years to identify prevention techniques, ranging from more hand washing by hospital workers to more diligence about the use of vein catheters.
All HCA hospitals followed the basic protocols set by the CDC to prevent bloodstream infections but took extra measures in a study that was designed to identify the best way to reduce the presence of methicillin-resistant Staphylococcus aureus in intensive care units. While MRSA cultures were reduced by 37 percent, the reduction of all types of bloodstream infections was 44 percent.
The antimicrobial soap used to bathe patients up to the neck area contained chlorhexidine. The nasal ointment contained mupirocin.
There is a human element beyond what the numbers show, Perlin said, especially if hospitals stop screening and isolating MRSA carriers.
“Isolation is isolating,” he said. “These are fragile patients who benefit from social interactions,” he said.