A recent study of nearly 75,000 patients describes two simple techniques that decreased by more than a third the risk of patients developing a type of bacterial infection resistant to certain antibiotics.
In addition, the number of bloodstream infections caused by this resistant infection dropped by nearly half.
"It's very exciting and gratifying. We had a positive result, of reducing infection and limiting antibiotic resistance," said Dr. Mary Hayden, associate professor of infectious diseases and pathology at Rush University Medical Center, and a co-author of the study, which The New England Journal of Medicine published in May.
"All clinical infections declined," she said.
The study demonstrates that to reduce the risk of infection by the methicillin-resistant Staphylococcus aureus, or MRSA, care providers must clean the skin of all intensive-care patients each day with antiseptic wipes containing chlorhexidine and apply an antimicrobial ointment to their noses.
The study included almost 75,000 patients in 74 adult intensive-care units in 43 hospitals during a 21/2-year period.
"Very few of this type of study have been done before. It's very encouraging, and I hope more studies like this are done," Hayden said.
It's not easy to carry out and finish such a large study, with obstacles such as getting people to participate and following the procedures for the duration of the research, she said.
There were three main outcomes, Hayden noted. The first was that the presence of MRSA among intensive-care unit patients dropped by 37 percent. The second was that all bloodstream infections decreased by 44 percent. The third was that MRSA bloodstream infections decreased, but by an amount that was not "statistically significant," she said.
A major problem with MRSA is that it is "resistant to first-line antibiotics," such as penicillin, Hayden said. This makes the disease "harder to treat."
This drug resistance means that care providers must substitute second-line antibiotics for the first-line medications. However, second-line are "more expensive, more toxic and less effective," she said.
The research included three different approaches to care. The first isolated patients who were screened and found to be carrying MRSA and provided them with routine care; the second isolated MRSA carriers, bathed them with medicated soap containing chlorhexidine and treated them with a nasal ointment; and the third did no MRSA screening but treated each patient with a chlorhexidine bath and nasal ointment.
The research took place within hospitals that are all part of the Hospital Corporation of America (HCA) system, which is one of the largest operators of private hospitals and clinics worldwide.
"A lot of coordination was involved," Hayden said. "It was a huge team effort."
The other paper authors were from several universities, HCA, research programs at two Department of Health and Human Services' agencies, the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention.
For future research, one question to investigate is whether a similar study would be effective in non-intensive-care unit settings, Hayden said.
Dr. Suzanne Bradley, infection control program director and internal medicine professor at the University of Michigan Medical School, called the trial "particularly impressive, given the number of hospitals and ICUs involved across the United States and the almost 75,000 patients involved."
"The simplicity and practicality of the study design seems to have been a major factor in the success and compliance with this trial," she said. "Even hospitals with little research experience or resources were able to participate, and this bodes well for wider implementation of this approach."
"Proving that infection control interventions work has been a challenge for this field," Bradley said. "This study is a significant achievement in that regard."