Share This Page

Health pros skeptical about hospital infection advice

| Monday, June 3, 2013, 12:01 a.m.
This undated photo provided by the Center for Disease Control shows plates of Methicillin-Resistant Staphylococcus Aureus in the CDC's health care-associated infections laboratory. A recent study published last week in the New England Journal of Medicine suggests at decontaminating all intensive care patients as the best way to reduce infections.

Hospital infections kill thousands of patients in the United States each year, but many doctors screen only a select few high-risk patients, according to a new study that drew mixed reviews from Pittsburgh experts.

The study, published last week in the New England Journal of Medicine, suggests ditching the screening and instead decontaminating all intensive care patients by washing them with antiseptic wipes and giving them antibiotic nose ointment as the best way to reduce infections.

Dr. Carlene Muto, UPMC's medical director of infection control and hospital epidemiology, said she thinks the study “has lots of flaws.”

She said screening patients and then isolating those who are infected is important because it can help prevent the spread of dangerous germs.

“We should know who has them,” Muto said, adding that UPMC uses medicated soap across the health care system.

Muto and Laura Morris, senior infection preventionist at St. Clair Hospital in Mt. Lebanon, feared that using the mupirocin nose ointment treatment for all ICU patients, as was done in the study, could cause germs to become resistant to the important antibiotic.

The study targeted ICU patients, who tend to be older, sicker, weaker and most likely to be infected with dangerous bacteria, including drug-resistant staph. It found that 54 patients would need to be decontaminated to prevent one bloodstream infection.

“We've definitely shown that it is better to target high-risk people,” not high-risk germs, said the study's lead author, Dr. Susan Huang, a researcher and infectious-disease specialist at the University of California, Irvine.

The decontamination method in the study worked like this: For up to five days, 26,000 ICU patients at more than 40 hospitals got a nose swab twice a day with bacteria-fighting ointment, plus once-daily bathing with antiseptic wipes.

Afterward, they were more than 40 percent less likely to get a bloodstream infection of any type than patients who had been screened and isolated for MRSA, or methicillin-resistant Staphylococcus aureus.

In the year before the experiment began, there were 950 bloodstream infections in intensive care patients at the hospitals studied, all part of the Nashville-based Hospital Corporation of America system. The results suggest that more than 400 of those could have been prevented if all hospitals had used the decontamination method.

Hospital Corporation of America said it is adopting universal ICU decontamination.

Dr. Robert Keenan, vice president and chief quality officer for Allegheny General and West Penn hospitals, said the hospitals began using antiseptic wipes on all ICU patients after a spike in central-line infections, or those obtained intravenously, 1½ years ago. Infection rates since have dropped, he said.

“For our purposes, this study validates what we are doing with (the antiseptic) wipes,” Keenan said.

Keenan said hospital officials have “talked seriously” about using the nasal treatments in elective surgical patients in certain high-risk situations, such as joint replacements.

“This (study) is another piece of evidence that is very strong, but we don't want to be doing something without clear evidence that there is a benefit,” Keenan said, adding he felt one weakness of the study was that it didn't show the “relative contribution” of the antiseptic wipes and nose ointment treatment, respectively, in reducing infection.

Morris said the study won't change the way St. Clair Hospital operates.

“Given what we're doing now and with our (infection) rates as low as they are, we're not planning any changes,” Morris said.

Morris said St. Clair has followed standard national guidelines to reduce central-line infections, including requiring staff to wear masks, caps and gowns, for seven years. According to the latest state Department of Health data, St. Clair's overall hospital-acquired infection rate of 2.10 cases per 1,000 patient hospital days is better than the state average of 2.22.

Statewide, Pennsylvania hospitals reported 22,713 hospital-acquired infections in 2011, down 12 percent from two years earlier, the data show.

About a decade ago, hospital-linked invasive MRSA infections sickened more than 90,000 people nationwide each year, leading to about 20,000 deaths. As hospitals improved cleanliness through such measures as better hand-washing and isolating carriers of deadly germs, those numbers dropped by about a third, with fewer than 10,000 deaths in 2011, according to the Centers for Disease Control and Prevention.

The Associated Press contributed to this report. Tom Fontaine is a staff writer for Trib Total Media. He can be reached at 412-320-7847 or tfontaine@tribweb.com.

TribLIVE commenting policy

You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.

We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.

While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.

We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers

We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.

We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.

We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.

We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.