A new study published online Wednesday by the New England Journal of Medicine demonstrates the effectiveness of using antimicrobial soap and ointment on all intensive-care unit (ICU) patients to reduce the burden of methicillin-resistant Staphylococcus aureus (MRSA), and decrease bloodstream infections. The study was first presented at IDWeek in October 2012, a joint annual meeting of leading infectious diseases organizations, and may lead to live-saving changes in prevention practices. The Society for Healthcare Epidemiology of America (SHEA) says it is encouraged by the findings and hopes the study will help inform and advance evidence-based infection prevention practices and policies.
“The results highlight that the widespread practice of active detection and isolation may not be the best answer to reducing the transmission of MRSA,” says Daniel Diekema, MD, president-elect of SHEA. “The healthcare field must continue to look to rigorous, evidence-based research like this when considering infection prevention strategies.”
The findings could also reduce healthcare costs since a common state-mandated method of “screening and isolation” to fight MRSA in the ICU was shown to fall short in protecting patients. Researchers determined that the best way to protect vulnerable ICU patients from MRSA and other pathogens causing bloodstream infections was through treating all ICU patients with preventive measures. This simpler prevention strategy reduced MRSA by 37 percent and reduced all bloodstream infections by 44 percent. Further research is needed to determine the relative benefit of mupirocin in addition to Chlorhexidine Gluconate (CHG) bathing and to assess the risk for emerging resistance to both topical agents.
To date, nine states currently have mandates for MRSA screening. A commentary by Michael Edmond, MD, MPH, and Richard Wenzel, MD, accompanying the study highlighted the need to scrutinize “legislative mandates when evidence is lacking.”
“Reducing the burden of healthcare-associated infection is essential, but our approaches and guidance must be grounded in research, rather than mandated by legislative action,” says Diekema. “This study serves as an example of SHEA and its members’ commitment to using science and evidence to drive infection prevention practices and policies.”
SHEA first advocated against the use of legislative mandates to drive prevention practice in a 2007 joint position statement by SHEA and the Association of Professionals in Infection Control and Epidemiology (APIC). SHEA says it welcomes efforts to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare-associated infections and supports ongoing additional research to determine and optimize prevention strategies.