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Fighting superbugs in ICUs and nursing homes

July 31, 2018 | UCI Health
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In the fight against multidrug-resistant organisms, or “superbugs,” UCI Health infectious diseases expert Dr. Susan S. Huang has long been a superwoman.

Her groundbreaking clinical trial, published in the New England Journal of Medicine in 2013, demonstrated that a simple protocol known as “decolonization” could dramatically decrease superbugs in intensive care units.

Reducing MRSA and blood stream infection rates

The protocol involves bathing patients’ skin when they are first admitted to an ICU with a soap containing the antibacterial agent chlorhexidine and cleaning their nostrils with an antibiotic ointment to remove germs.

“With decolonization, we reduced the superbug MRSA (methicillin-resistant Staphylococcus aureus) by 37 percent and reduced all bloodstream infections by 44 percent,” says Huang, director of epidemiology and infection prevention at UC Irvine Medical Center.

Thanks to Huang, decolonization is now considered best practice in all U.S. intensive care units to protect patients from an alphabet soup of superbugs (known by their acronyms):

  • MRSA
  • VRE
  • CRE
  • ESBL-producers

Superbugs can kill the elderly and sick

For patients who are elderly, sick or frail, contracting a superbug can be deadly. That’s why Huang is involved in two large-scale decolonization projects involving vulnerable patients: those in nursing homes, long-term acute care facilities and general hospital medical and surgical units.

The studies are known as the Protect Trial and the SHIELD Orange County project.

The Protect Trial, now underway, involves 28 nursing homes in Orange County and southern Los Angeles County. Half the nursing homes are following routine bathing and hygiene procedures; the others are practicing decolonization.

Healthy people can be superbug carriers

Because non-infected patients can be unwitting carriers of multidrug-resistant organisms, decolonization can reduce the spread of superbugs to others and prevent patient infections.

“People who carry these organisms are at higher risk for drug-resistant infections later,” says Huang, “especially if they have breaks in their skin, have undergone surgery or have bedsores. They’re also at a higher risk for developing pneumonia.”

SHIELD a regional collaboration

The SHIELD project is a regional collaboration funded by the U.S. Centers for Disease Control and Prevention (CDC). Using Orange County data and a mathematical simulation model, Huang and her research team identified 17 hospitals, 18 nursing homes and three long-term acute care facilities that together share the most patients.

These 38 facilities have adopted a decolonization intervention:

  • The nursing homes and long-term acute care facilities switched to a chlorhexidine bathing soap and are applying an over-the-counter iodine-based swab to the nose.
  • In hospital wards, the project targets patients who are already known to harbor superbugs.
  • And, in the hospitals’ ICUs — because it’s the standard of care — all patients receive the chlorhexidine bath and nasal swab intervention.

Alarming numbers in early sample

“Before we began the SHIELD Project, we sampled people in these facilities and found that 64 percent of residents in nursing homes and 80 percent of the long-term acute-care patients had a multidrug-resistant organism,” she says. “These numbers are alarming when you consider the number of people we need to protect.”

The problem, Huang explains, is two-pronged: People are more likely to get multidrug-resistant organisms when they receive antibiotics that kill off susceptible bacteria, leaving in place ones that are more resistant.

Hands-on care can spread contagion

Patients in hospital, nursing home and long-term care settings also require hands-on care, which can spread contagion.

“That’s why these simple interventions we’re implementing can make a big difference,” she says.

Over time, Huang believes the SHIELD Project can actually reduce Orange County’s drug-resistant organisms. “If we can control disease among high-risk patients,” she says, “then it’s possible we will do good for the entire community.”

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