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REDUCE MRSA: From Novel Idea to 74,000 Patients

Categories: Antimicrobial Resistance, MRSA

John Jernigan, M.D.

John Jernigan, M.D.

Author – John Jernigan, MD, MS
Director of CDC’s Office of Prevention Research and Evaluation and head of CDC’s Prevention Epicenters Program.

I am excited to announce the results of the REDUCE MRSA study which evaluated three current strategies for preventing methicillin-resistant Staphylococcus aureus (or MRSA) among adult critical care patients. This study – one of the largest to date on this subject, including over 74,000 patients — was recently published in the New England Journal of Medicine.   The study shows that using antimicrobial soap and ointment on all intensive-care unit (ICU) patients can reduce bloodstream infections caused by MRSA and other germs by 44 percent. 

The study is important for several reasons.  First, it answers questions about control of antimicrobial resistant organisms and other healthcare-associated infections, and offers a promising new approach to protecting patients and saving lives.  The study is also important because it demonstrates how creating the right partnerships can help us advance the science of patient safety.  This study was made possible through a unique collaborative partnership having its roots in the CDC Prevention Epicenters Program, a group of CDC-funded researchers who work together with CDC scientists to explore novel approaches to save patients from healthcare-associated infections.  Early research from these investigators and others conducted on a very small scale in single hospitals suggested that reducing germs on patient’s skin by bathing with a skin antiseptic would decrease transmission of pathogens and potentially prevent infections. To build on these results and to fill gaps in our knowledge about how best to prevent MRSA infection, CDC continued to partner with its Prevention Epicenter investigators, led by  University of California, Irvine,  and Harvard Pilgrim Health Care Institute, to design the REDUCE MRSA trial. We couldn’t do it alone, however.  The study design required us to partner with a large hospital network that was willing work with us to incorporate scientific method into the everyday delivery of care, essentially becoming a learning healthcare system, and Hospital Corporation of America (HCA)  accepted the invitation to participate. Subsequently, we approached the Agency for Healthcare Research and Quality to provide funds for the study, and our partnership was complete.

Making Infection Prevention “Simple”

Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA

Susan Huang, MD, MPH

Susan Huang, MD, MPH

Guest Author – Susan Huang, M.D., M.P.H
Lead author of the REDUCE MRSA study
Associate Professor, UC Irvine School of Medicine
Medical Director of Epidemiology and Infection Prevention, UC Irvine Health

For years, we have searched for new strategies to turn the tide against antibiotic-resistant pathogens in healthcare facilities.

In particular, Methicillin-resistant Staphylococcus aureus (or MRSA) has become a common threat to patients. MRSA is spreading in both community and healthcare settings and can cause severe disease, particularly among patients in intensive care units.  Patients who have MRSA on their bodies are at increased risk of developing a MRSA infection and healthcare personnel can spread the bacteria from them to other patients. 

Today, I would like to share with you the exciting results from a study known as the REDUCE MRSA trial. The study, published in today’s New England Journal of Medicine, was conducted at 43 hospitals within the Hospital Corporation of America health system. The REDUCE MRSA trial was carried out by a multidisciplinary team from the University of California, Irvine; Harvard Pilgrim Health Care Institute; Rush University; Stroger Hospital of Cook County; Washington University in St. Louis; HCA; and CDC. The trial was federally funded by and conducted through research programs at the Agency for Healthcare Research and Quality (AHRQ) and the CDC’s Prevention Epicenters program

The intervention involved nearly 75,000 patients and more than 280,000 patient days in 74 adult ICUs located in 16 states. The study randomized hospitals to the following three prevention strategies:

What People Are Saying About the REDUCE MRSA Trial

Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA

The REDUCE MRSA trial was published in today’s New England Journal of Medicine and took place in two stages from 2009-2011. A multidisciplinary team from the University of California, Irvine, Harvard Pilgrim Health Care Institute, Hospital Corporation of America (HCA) and the Centers for Disease Control and Prevention (CDC) carried out the study. The study was funded by Agency for Healthcare Research and Quality (AHRQ) with contributions from HCA and CDC. See below for quotes from the multidisciplinary team:

Tom Frieden, MD, MPH, Director, Centers for Disease Control and Prevention

Frieden, MD, MPH
Director, Centers for Disease Control and Prevention


“CDC invested in these advances in order to protect patients from deadly drug-resistant infections. We need to turn science into practical action for clinicians and hospitals. CDC is working to determine how the findings should inform CDC infection prevention recommendations.” — Dr. Tom Frieden, M.D., M.P.H., CDC Director

John Jernigan, MD

John Jernigan, MD


“This study demonstrates what can be accomplished for patient safety when we create the right partnerships. This unique collaboration between public health scientists, academic investigators, and private hospitals allowed us to take novel infection prevention strategies to patients’ bedside. With these critical partnerships, we can better protect patients and make healthcare safer.” – John Jernigan, M.D., director of CDC’s Office of Prevention Research and Evaluation and head of CDC’s Prevention Epicenters Program.

Carolyn Clancy, MD

Carolyn Clancy, MD


“Patients in the ICU are already very sick, and the last thing they need to deal with is a preventable infection. This research has the potential to influence clinical practice significantly and create a safer environment where patients can heal without harm.” — Carolyn M. Clancy, M.D., Agency for Healthcare Research and Quality (AHRQ) Director

Preventing MRSA in healthcare – Is there a silver bullet? (Part 1 of 3)

Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA

John Jernigan, M.D.

John Jernigan, M.D.

Author: John Jernigan, M.D
Director for CDC’s Office of HAI Prevention Research and Evaluation, Division of Healthcare Quality Promotion

The optimal approach to controlling MRSA in healthcare facilities has been a topic of ongoing controversy. Of particular interest is the question of whether the use of active detection and isolation of patients colonized with MRSA, also known as ADI, should be routinely used. Despite ongoing research and vigorous scientific debate, a simple answer has remained elusive. This week, two studies were published in the New England Journal of Medicine that illustrate the complexities of the scientific evidence surrounding ADI. One of these studies, the STAR*ICU Trial (Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care), found that ADI as implemented in the study was not effective in reducing transmission of MRSA or VRE. A separate observational study (Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections) involving the entire national VA hospital system
, found that after implementing a multifaceted MRSA prevention program that included ADI, MRSA transmissions and HAIs decreased significantly. The fact that these studies seem to give different answers illustrates the challenge we as scientists face in making recommendations on how best to use limited prevention resources-sometimes the answers aren’t simple as we would like.

Preventing MRSA in healthcare – Is there a silver bullet? (Part 2 of 3)

Categories: Antimicrobial Resistance, Healthcare-associated infections, MRSA

Martin Evans, MD

Martin Evans, MD

Author: Martin Evans, MD
Director of the VHA MRSA/MDRO Program

MRSA hospital-acquired infections (HAIs) cause increased suffering, the need for increased procedures, treatments, and time in the hospital, and sometimes an increased risk of death among patients. Beginning in 2002, staff working at the VA Pittsburgh Healthcare system successfully brought down MRSA HAIs using a “bundle” of infection control strategies. In 2007, VA leadership in Central Office, Washington, D.C. decided to have all 153 medical centers nationwide implement the bundle.

The “MRSA bundle” consisted of gently swabbing the nose of all patients admitted or transferred within the hospital to detect those carrying MRSA (known as universal active surveillance); preventing spread of the organism by placing those with MRSA in their own room away from those not carrying the organism; insisting that healthcare workers do hand hygiene and wear gloves and gowns when caring for the patient, and striving for a culture change where infection prevention and control becomes everyone’s responsibility.

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