Health pros skeptical about hospital infection advice
By Tom Fontaine
Published: Monday, June 3, 2013, 12:01 a.m.
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 email@example.com.
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