June 20, 2013
Belton Regional Medical Center, Lee’s Summit Medical Center, Menorah Medical Center and Overland Park Regional Medical Center, part of HCA Midwest Health System—Kansas City’s largest healthcare provider and private-sector employer—recently participated in a comprehensive infection prevention study with 39 other HCA hospitals. The study was conducted exclusively at 43 HCA-affiliated hospitals nationwide. The study was recently published in the New England Journal of Medicine.
Known as Randomized Evaluation of Decolonization Versus Universal Clearance to Eliminate (REDUCE) MRSA, the study was conducted in conjunction with investigators at Harvard and several other academic institutions, and research programs at two U.S. Department of Health and Human Services agencies, the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC). The use of antimicrobial agents on an entire patient population is referred to as universal decolonization. The study found that using antimicrobial soap and ointment to decolonize all intensive care unit patients reduced all bloodstream infections, including MRSA by 44 percent.
“HCA and its hospitals nationwide are continuously seeking ways to provide the highest quality patient care possible,” says Darryl Nelson, MD, HCA Midwest Health System Chief Medical Officer. “It is our commitment to continually improve our high standards of care to give patients the best outcome possible. We are pleased four HCA Midwest Health System hospitals participated in this groundbreaking study.”
The study’s findings suggest a major change in healthcare practice that could improve the quality of care in every hospital and save lives. As a result of the findings, HCA is in the process of implementing universal decolonization in its adult intensive care units in each of its hospitals.
“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,” says Jonathan B. Perlin, MD.
President, Clinical and Physician Services Group and Chief Medical Officer of HCA. “These compelling results convinced us to implement this protocol in HCA hospital adult ICUs. 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.”
The study, which involved nearly 75,000 patients and more than 280,000 patient days in 74 adult ICUs located in 16 states, compared the results of three approaches in ICUs:
- Screen all patients and isolate MRSA carriers
- Targeted decolonization: screening, isolation, and decolonization of MRSA carriers with chlorhexidine and mupirocin ointment
- Universal decolonization: no screening and all patients decolonized with chlorhexidine and nasal mupirocin ointment.
The REDUCE MRSA team found that using universal decolonization reduced MRSA clinical cultures by 37 percent. Patients colonized with MRSA may not be sick, but they are at risk for later illness and for spreading it to others. All bloodstream infections were decreased by 44 percent. The researchers noted that this trial took place in HCA hospitals, mostly in community hospitals, rather than academic institutions and was conducted by hospital personnel rather than specially trained research staff. Therefore, unlike some clinical studies, these results are likely to be applicable to nearly all U.S. hospitals.
“It is exciting that Lee’s Summit Medical Center was part of this national practice-changing health care study,” says Lee’s Summit Medical Center Chief Executive Officer Jackie DeSouza. “The implementation of new standards of care based on the results of this study can positively impact hospital patients far beyond the walls of Lee’s Summit Medical Center. This is very good news for patient care.”
“The unprecedented partnership of Menorah Medical Center with 42 other HCA hospitals throughout the country has yielded significant findings,” says Steve Wilkinson, FACHE, President and Chief Executive Officer of Menorah Medical Center. “It will help make prevention of MRSA and other serious infections simpler and more effective and also sets a new standard for responsible infection prevention.”
"This study demonstrates what can be accomplished for patient safety when we create the right partnerships,” says John Jernigan, MD, MS, Director of CDC’s Office of Prevention Research and Evaluation and head of CDC’s Prevention Epicenters Program. “This unique collaboration between public health scientists, academic investigators and private hospitals allowed us to take novel infection prevention strategies to patients’ bedside. With these critical partnerships, we can better protect patients and make healthcare safer.”
REDUCE MRSA was a collaborative effort. The study concept and design was created by investigators in the CDC’s Prevention Epicenter Program at the University of California, Irvine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Rush University and Washington University in St. Louis. AHRQ’s Healthcare Associated Infections program provided funding, and the research was conducted through AHRQ’s Developing Evidence to Inform Decisions about Effectiveness (DECIDE) network.