Hospitals can sharply reduce the spread of the drug-resistant bacteria in their intensive care units by decontaminating all patients rather than screening them and focusing only on those found to be infected already, researchers reported Wednesday.
A study involving more than 74,000 patients in 74 intensive care units nationwide found that cleaning all ICU patients with a special soap and ointment reduced all infections, including MRSA, by 44 percent. For the patients in group that got disinfected no matter what, there were 3.6 infections per 1,000 days in the hospital. That result compared with a baseline of 6.1 infections per 1,000 days beforehand.
The study, published in The New England Journal of Medicine, is the largest to evaluate strategies for controlling infections with MRSA, or methicillin-resistant Staphylococcus aureus. Infections with these "superbugs" have become a big problem.
"Patients in the ICU are already very sick, and the last thing they need to deal with is a preventable infection," said a statement by Dr. Carolyn M. Clancy, head of the federal Agency for Healthcare Research and Quality, which funded the study. "This research has the potential to influence clinical practice significantly and create a safer environment where patients can heal without harm."
Some states have started requiring hospitals to screen patients for MRSA. This study tried to figure out if that was really the best strategy.
For the study, hospitals were randomly asked to try one of three strategies: testing ICU patients for MRSA and isolating those infected; testing patients for MRSA and disinfecting those infected; or disinfecting all patients.
The researchers found that disinfecting all patients was much more effective inreducing MRSA and other infections, too.
"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," said Dr. Susan Huang of the University of California, Irvine, who led the study, in the news release.
"The universal decolonization strategy was the most effective and the easiest to implement," she said. "It eliminates the need for screening ICU patients for MRSA."
The researchers said the approach could also be effective for reducing other emerging infections that are resistant to treatment.
They cautioned, however, that doctors will have to watch closely to make sure the germs don't become resistant to the disinfecting soaps and ointments.
In an editorial accompanying the study, Dr. Michael Edmond and Dr. Richard Wenzel of Virginia Commonwealth University School of Medicine said the study illustrates the "folly of pursuing legislative mandates when evidence is lacking." State laws mandating MRSA screening should be repealed, they say.