Portsmouth Regional and Parkland Medical Center in Derry, two New Hampshire hospitals that are part of HCA Healthcare, have been cooperatively involved in a nationwide clinical trial. The trial’s central focus is discovering the most effective strategies to prevent healthcare-associated intensive care unit (ICU) infections, which pose severe threat to patient well-being. A joint effort led by the Centers for Disease Control and Prevention, Harvard Pilgrim Health Care Institute, University of California, Irvine, and HCA Healthcare allowed the study to include a whopping 800,000-plus ICU patients across 137 HCA hospitals.
The trials brought to light that mupirocin, a nasal antibiotic ointment, demonstrated superior efficacy in averting Staphylococcus aureus infections in gravely sick patients as compared to antiseptic solutions. The findings build upon a previous trial conducted by the same syndicate of researchers. They determined that regular bathing using antiseptics, specifically chlorhexidine soap along with nasal mupirocin for ICU patients, provides a significant reduction in severe infections including bloodstream ones.
This method is dubbed ‘decolonization’, given that it lowers the overall body bacterial load to curb infection risks. Interestingly, despite its success, currently only around a third of hospital ICUs apply nasal mupirocin to all patients, a reluctance largely attributed to potential risks of breeding antibiotic resistance. Given these apprehensions concerning potential antibiotic resistance, the researchers attempted a comparison between mupirocin and another nasal antiseptic product, povidone-iodine, also known as iodophor.
According to Kenneth Sands, M.D. MPH, the chief epidemiologist at HCA Healthcare, the research further confirmed the efficacy of the mupirocin CHG protocol, leading to its implementation and universally endorsing mupirocin as the preferred agent for nasal decolonization across all hospitals.
The trial spanned 18 states and included 137 community hospitals under HCA Healthcare. Approximately half kept administering mupirocin nasal ointment as a standard practice for ICU patients, while the remainder shifted to nasal povidone-iodine. Regardless, all involved hospitals applied the nasal product for five days followed by daily chlorhexidine baths. The findings underscored mupirocin’s sustained benefits. It was noticed that even a decade of using the antibiotic ointment within HCA Healthcare hadn’t decreased its effectiveness, giving similar persistent clinical advantages even after nearly ten years of continuing ICU use.
This revelation carries crucial significance in the face of increasing antibiotic resistance risks tied to widespread antibiotic deployment. The research, known as The Mupirocin-Iodophor Swap Out Trial, demonstrated 18% lesser protection from staph infections in cases where mupirocin was substituted with iodophor. The trial provides strong evidence supporting bacterial skin and nasal decolonization as a protective measure against infection during high-risk periods.