If hospitals want to cut down on readmissions related to hospital-acquired infections, specifically methicillin-resistant Staphylococcus aureus or MRSA, then implementing a bathing protocol as part of the discharge instructions and best practices is key. That's the finding of a study from Rush University published in a February issue of the New England Journal of Medicine.
The study illustrated results from the Changing Lives by Eradicating Antibiotic Resistance, or CLEAR, trial. The trial involved 2,121 adult patients at random divided into two groups. All patients carried MRSA on their bodies.
One group was educated in infection prevention measures related to personal hygiene, laundry and cleaning in the home. The other group got the same education and was also instructed on how to decolonize their bodies of MRSA. The treatment regimen included bathing or showering with an over-the-counter antiseptic soap, rinsing the mouth and throat with a prescription mouthwash, and applying an antibiotic ointment to the nose. Patients were instructed to perform the regimen daily for five days, twice a month, for six months.
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The results were clear: Of the group that only received education, one out of every 11 participants developed a MRSA infection and one in four developed a serious infection from any pathogen. Moreover, 85 percent of those infections led to hospitalization.
The group that was both educated and instructed in the decolonization bathing regiment saw a 30 percent drop in MRSA infections compared to the education-only group. The overall infection rate was reduced by 17 percent. Finally, those who were consistent with the decolonization bathing protocol and did not miss "dose" had 44 percent fewer MRSA infections and 40 percent fewer infections overall.
The study shows that a bathing protocol like the one utilized had a significant impact in thwarting infections that could have parlayed into costly readmissions and patient harm. Since the education-only group not only saw a higher rate of infection but also saw a high rate of hospitalization associated with those infections, it's clear that HAIs drive costs for providers and negatively impact patient outcomes, which can affect patient loyalty as well.
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Data from the Centers for Disease Control indicates MRSA carriers who are discharged from hospitals are at high risk of serious disease due to MRSA the year after discharge and roughly 5 to 10 percent of hospitalized patients carry MRSA.
The study was conducted through a collaboration between the University of California Irvine, Los Angeles Biomedical Research Institute at Harbor-UCLA, and Rush University. Participants in the study were adults able to bathe or shower either on their own or with help from a caregiver. They were recruited from 17 hospitals and seven nursing homes in Southern California, had been hospitalized in the previous 30 days, and tested positive for MRSA while in the hospital or 30 days before or afterward.
California law requires MRSA screening upon admission in high-risk patients.
Researchers tracked the patients for 12 months following discharge, contacting them monthly and asking them to report hospitalizations or clinic visits for infection. They also met them in their homes or in a research clinic four times. At the end of the year, they did an exit interview and medical records from the study period were analyzed.
ON THE RECORD
"Our goal was to understand whether removing MRSA from the skin, nose and throat was better than hygiene education alone in reducing MRSA or other infections and associated hospitalizations," said Dr. Mary Hayden, professor of internal medicine and pathology, chief of the Division of Infectious Diseases, and director of the Division of Clinical Microbiology at Rush University Medical Center.
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