REDUCE MRSA

REDUCE MRSA, which stands for Randomized Evaluation of Decolonization vs. Universal Clearance to Eliminate methicillin-resistant Staphylococcus aureus (MRSA), was designed to find a simple solution to prevent healthcare-associated infections (HAIs). HAIs, including those caused by MRSA, are a leading cause of preventable illness and death. Reducing MRSA is a priority because these bacteria can cause severe disease, are resistant to treatment, and are increasingly common in healthcare settings, particularly among intensive care unit (ICU) patients.

The REDUCE MRSA studyExternal Web Site Icon was designed to assess the comparative effectiveness of three principal strategies for the prevention of MRSA in ICUs. The research was conducted in partnership with the Hospital Corporation of America (HCA) and nearly four dozen of its affiliated facilities. The study concept and design was created by experts at CDC and the CDC Prevention Epicenter Programs at University of California, Irvine and Harvard Pilgrim Health Care Institute. The study, published in the New England Journal of Medicine, was funded by and conducted through 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). Visit AHRQ’s website for more information about the REDUCE MRSA studyExternal Web Site Icon.

Prevention Epicenter Collaborators

The pilot work and development of study design for this 18-month trial was funded through CDC’s Prevention Epicenter Cooperative Agreement. The pilot work was a result of a multi-site HAI prevention research project including:

• The Chicago Antimicrobial Resistance and Infection Prevention Epicenter (C-PIE)
• The Harvard/Irvine Bi-Coastal Epicenter
• Washington University and Barnes Jewish County (BJC) Center for Prevention of Healthcare-Associated Infections.

Results of the Study

Researchers at Harvard Pilgrim Health Care Institute and the University of California Irvine found that treating all ICU patients as if they carry MRSA on their bodies can reduce bloodstream infections from MRSA and other germs by more than 40 percent. Hospitals are now implementing this novel strategy to improve antibiotic resistance prevention among ICU patients.

The study was conducted in 74 ICUs in 43 HCA hospitals and involved nearly 75,000 patients in 16 states. Researchers evaluated the effectiveness of three common MRSA prevention practices:

• Prevention strategy one: Routine care
  This strategy involved screening (testing) patients for MRSA when they were admitted to the ICU. Health care providers used gloves and gowns when caring for patients who tested positive for MRSA. Among patients in ICUs that applied this prevention strategy, neither the presence of MRSA nor bloodstream infections were significantly reduced.
• Prevention strategy two: Bathing and treating patients who carry MRSA
  This strategy involved screening (testing) patients for MRSA upon entering the ICU. Healthcare providers used gloves and gowns when caring for patients who tested positive for MRSA, and these patients were bathed daily with a 2 percent chlorhexidine (an antiseptic that is safe for the skin) containing cloth, and had an antibiotic ointment called mupirocin applied twice daily inside their nose (the body site most commonly colonized with Staphylococcus aureus) for 5 days. Among patients in ICUs applying this strategy, bloodstream infections caused by all germs combined were reduced by 23 percent.
• Prevention strategy three: Bathing and treating all ICU patients (universal decolonization)
  This strategy involved not testing patients for MRSA when they entered the ICU. Instead, all patients were bathed daily with a 2 percent chlorhexidine cloth and received mupirocin ointment twice daily inside their nose for 5 days. Gloves and gowns continued to be used when treating patients who tested positive for MRSA. Among patients in these ICUs, the presence of MRSA was reduced 37 percent, and bloodstream infections caused by all germs were decreased by 44 percent. Of the three strategies studied, this strategy was found to be the most effective at reducing infections.

This research was funded by AHRQ. You can read more about the REDUCE MRSA study in The New England Journal of Medicine (NEJM).