October 18, 2023
Two HCA New England Healthcare hospitals collaborated on a nationwide clinical trial focused on the best strategies to prevent life-threatening healthcare-associated intensive care unit infections. The Centers for Disease Control and Prevention, Harvard Pilgrim Health Care Institute, and the University of California, Irvine, co-led the study along with HCA Healthcare, which involved more than 800,000 ICU patients in 137 HCA Healthcare hospitals. They discovered that a nasal antibiotic ointment, mupirocin, outperformed an antiseptic solution at preventing Staphylococcus aureus infections in critically ill patients.
This study built upon an earlier study among these research partners, which demonstrated that daily bathing with antiseptic chlorhexidine soap plus nasal mupirocin for all ICU patients prevented many bloodstream and other serious infections. This strategy is called “decolonization” because it reduces the amount of bacteria on the body in order to reduce infection risk. Today, as a result of the previous study, the majority of ICUs bathe patients with chlorhexidine; however, only one-third of hospital ICUs provide nasal mupirocin to all patients, largely due to fears of fueling antibiotic resistance. Because of a concern that disease-causing bacteria might become resistant to mupirocin, the investigators compared mupirocin to an alternative nasal antiseptic product, known as povidone-iodine or iodophor.
“HCA Healthcare is honored to continue collaborating with the CDC, UCI Health, and the Harvard Pilgrim Health Care Institute to leverage our scale to answer clinical questions that will benefit patients everywhere,” said Kenneth Sands, MD MPH, chief epidemiologist at HCA Healthcare. “This new trial confirms the effectiveness of the mupirocin CHG protocol, and we have already put this science into practice, establishing universal use of mupirocin as the preferred agent for nasal decolonization in all hospitals.”
The 2 HCA New England Healthcare hospitals that participated in the trial are:
- Portsmouth Regional Hospital
- Parkland Medical Center
The 137 total participating community hospitals spanned 18 states and are part of HCA Healthcare, a leader in pragmatic research in real-life settings. Half of the hospitals continued their standard practice of treating ICU patients with mupirocin nasal ointment, and the other half switched to nasal povidone-iodine. All hospitals used the nasal product for five days plus chlorhexidine for daily bathing.
Importantly, this trial showed a durable benefit from mupirocin. The use of an antibiotic ointment for the past 10 years at HCA Healthcare did not diminish its impact. There was similar persistent clinical benefit even after nearly a decade of continuous ICU use, suggesting that use of chlorhexidine soap and mupirocin had not lost their effect. This is important because widespread antibiotic use can lead to antibiotic resistance in some instances.
Because of the size of the study and the fact that it was conducted at such a wide range of community hospitals, the results are generally believed to be applicable to hospitals across the country.
The study was conducted through a longstanding scientific consortium, including HCA Healthcare, Harvard Medical School’s Department of Population Medicine at the Harvard Pilgrim Health Care Institute, the University of California, Irvine, and the Centers for Disease Control and Prevention. This same scientific group conducted the REDUCE MRSA Trial over 10 years ago, which first showed that this decolonization regimen could reduce MRSA by 37 percent and bloodstream infections by 44 percent. Now, the Mupirocin-Iodophor Swap Out Trial showed that switching from mupirocin to iodophor produced 18 percent less protection from staph infections.
The Mupirocin-Iodophor Swap Out Trial adds to a growing set of evidence that reducing the amount of bacteria on the skin and in the nose through decolonization can protect patients from infection during high-risk moments. This same scientific group not only conducted the REDUCE MRSA Trial, but also the ABATE Infection Trial, which showed that decolonization of hospitalized patients with medical devices outside of the ICU reduces both bloodstream infections and antibiotic-resistant pathogens.