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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

Preserving Antibiotic Effectiveness: Everybody’s Responsibility

Categories: Antibiotic use, Antimicrobial Resistance

Ramanan Laxminarayan, PhD.

Ramanan Laxminarayan, PhD

Guest Author – Ramanan Laxminarayan, PhD
Director, Center for Disease Dynamics, Economics & Policy

To many, antibiotic resistance may seem like an evergreen issue that reappears in the news cycle periodically. However, recent reports of the emergence and spread of carbapenem-resistant Enterobacteriaceae, described in CDC’s March 2013 Vital Signs Report remind us that we stand at the threshold of the post-antibiotics era and that we have a responsibility to bring broader attention to this serious public health threat.

In November of last year, a group of 26 organizations came together to sign the Joint Statement on Antibiotic Resistance, an agreement that put forth bold principles for protecting our current supply of working antibiotics while urging the development of new ones. Among the goals listed is the need for continued efforts to educate a wider audience about the looming danger of running out of effective antibiotics.

Last week, Extending the Cure released an animated video that explains in clear and engaging terms how antibiotic resistance emerges, what it costs to society, and why antibiotics must be conserved as a communal resource, like water and trees.

The Role of the Healthcare Environment: Challenges and Opportunities in Reducing Healthcare-Associated Infections

Categories: Healthcare-associated infections

Kerri A. Thom, MD, MS

Kerri A. Thom, MD, MS

Guest Author – Kerri Thom, MD
Assistant Professor of Medicine
Division of Epidemiology and Public Health
University of Maryland School of Medicine

As leaders in infection control and prevention, healthcare epidemiologists and infection preventionists must work to educate other healthcare professionals, from the C-Suite to the frontline, on the need to incorporate comprehensive environmental cleaning and disinfection strategies to reduce HAIs. At the University of Maryland, we look to use data to demonstrate how evidence-based strategies can reduce environmental contamination. For example, using methods like fluorescent dye to capture the rate of high-touch surface disinfection, we are able to provide immediate feedback to frontline staff and to report data back to hospital management highlighting the frequency of cleanliness of these surfaces.

The Society for Healthcare Epidemiology of America’s (SHEA) Spring Meeting puts a spotlight on the impact of the healthcare environment in the spread of bacteria responsible for healthcare-associated infections. Healthcare environment research identifies the role of the healthcare environment to contaminate the hands of healthcare professionals, hospital surfaces and medical equipment. The goal of the meeting is to educate professionals in healthcare epidemiology and infection prevention on evidence-based research and policies in this area.

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