MRSA Study Slashes Deadly Infections in Sickest Hospital Patients

Electronic Newsletter, Issue 382

AHRQ's Electronic Newsletter summarizes Agency research and programmatic activities.

June 4, 2013

Today's Headlines

  1. MRSA Study Slashes Deadly Infections in Sickest Hospital Patients.
  2. Patient Safety Primer Highlights Trends in Disclosing Errors to Patients.
  3. Free MONAHRQ® Software Now Offers More Data Analysis, Measures, and Improved Reporting.
  4. AHRQ's May Issue of Web M&M Examines Patients' Role in Identifying Cancer Treatment Error.
  5. New AHRQ Video Series Profiles Health Care Innovators Making a Difference.
  6. More Research Needed to Effectively Prevent Blood Clots in Special Populations.
  7. AHRQ Review of Local Therapies for Hepatocellular Carcinoma Finds Insufficient Evidence for Comparison.
  8. AHRQ in the professional literature.

1. MRSA Study Slashes Deadly Infections in Sickest Hospital Patients

Preventing the spread of antibiotic-resistant infections is a major patient safety challenge for hospitals across the United States. One such infection, methicillin-resistant Staphylococcus aureus (MRSA), is a growing cause of illness and even death, especially among patients in hospitals and nursing homes. Three-quarters of all Staphylococcus aureus infections in hospital intensive care units (ICUs) are considered methicillin-resistant. However, a new study funded by the Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC) shows that using germ-killing soap (chlorhexidine) and ointment (mupirocin) on all patients admitted to the ICU can reduce all-cause bloodstream infections by up to 44 percent and MRSA clinical cultures by 37 percent. Study findings were published online May 29 in the New England Journal of Medicine. "Patients in the ICU are already very sick, and the last thing they need to deal with is a preventable infection," said AHRQ Director Carolyn M. Clancy, M.D. "This research has the potential to influence clinical practice significantly and create a safer environment where patients can heal without harm." The study, known as the REDUCE MRSA trial, involved more than 74,000 patients in 74 ICUs and was conducted in partnership with the Hospital Corporation of America (HCA) by researchers from the University of California, Irvine; Harvard Pilgrim Health Care Institute; and the CDC. The research was conducted in HCA hospitals from 2009 through 2011. Researchers evaluated the effectiveness of three MRSA prevention practices: following routine care, providing germ-killing soap and ointment only to patients with MRSA, and providing germ-killing soap and ointment to all ICU patients. The third prevention practice, decolonizing all patients who enter the ICU (universal decolonization), was found to be the most effective. Select to read the press release.

2. Patient Safety Primer Highlights Trends in Disclosing Errors to Patients

Patients and physicians have different concepts of what matters most when it comes to learning about disclosing an error, according to a Patient Safety Primer available on AHRQ's Patient Safety Network (PSNet). Patients want disclosure of all harmful errors, an explanation of why the error occurred, a sense of how the error's effect will be minimized, and the steps the physician and health care organization will take to prevent them from recurring. While most physicians agree in theory that an error should be fully disclosed, more than half supported "partial disclosure" in practice, by mentioning the adverse event without discussing their role in the error or its effect on patient health. Learn more about recent guidelines, trends, and ongoing research that's available to help physicians and health care organizations disclose errors to patients appropriately. Select to access the full patient safety primer, titled Error Disclosure.

3. Free MONAHRQ® Software Now Offers More Data Analysis, Measures, and Improved Reporting

AHRQ's new version 4.1 of MONAHRQ®—My Own Network Powered by AHRQ—offers free software to help users create customized Web sites for internal quality improvement or reporting quality information to the public. The tool significantly reduces the time and amount of money that organizations would otherwise need for compiling, analyzing, and posting comparison reports on quality of hospital care, its cost, and how that care is used. The latest version enhances an organization's ability to report hospital costs, provide information about hospital emergency department use, and summarize information by hospital and by county, among other improvements. Select to access MONAHRQ 4.1.

4. AHRQ's May Issue of Web M&M Examines Patients' Role in Identifying Cancer Treatment Error

The May issue of AHRQ Web M&M features a Spotlight Case describing how a 48-year-old man hospitalized for a chemotherapy protocol to treat metastatic penile cancer identified a medical error that would have increased his treatment regimen from 3 days to 5 days. Before the additional dose was administered, the patient asked to speak with the oncology team, which identified the incorrect chemotherapy regimen. The patient and the oncology team discussed the incorrect order, and the patient was released from the hospital with no adverse consequences. A commentary on the case is provided by Joseph O. Jacobson, M.D., MSc., associate clinical professor of medicine at Harvard Medical School, and Saul N. Weingart, M.D, Ph.D., associate professor of medicine at Harvard Medical School. The Perspectives on Safety feature section features an interview with Ashish K. Jha, M.D., Ph.D., professor of health policy and management at Harvard School of Public Health. Physicians and nurses can receive free CME, CEU, or training certification by taking the Spotlight Quiz. Select to read the current issue of AHRQ Web M&M.

5. New AHRQ Video Series Profiles Health Care Innovators Making a Difference

A new video series on AHRQ's Health Care Innovations Exchange profiles health care professionals whose policy innovations have influenced the structures, processes, or outcomes of care delivery. The innovators share stories that illustrate the key elements of their work and the impact on the lives of individuals. Videos and profiles and profiles feature: Bethany Hays, M.D., True North Health Center, Falmouth, ME, who explains how True North uses innovative policies to enhance access to care for low-income patients. Nancy Langenfeld, M.S., RN, Coordinated School Health Specialist, Charlotte, NC, describes how a local school district developed policies to lessen the impact of asthma on students. Arthur Garson, M.D., M.P.H., Director, Institute for Health Policy, University of Virginia, explains how clinics and hospitals involve community members to help ensure patients receive appropriate care. Select to access more innovations on policy and other topics on the AHRQ Health Care Innovations Exchange Web site, which contains more than 775 searchable innovations and 1,525 Quality Tools.

6. More Research Needed to Effectively Prevent Blood Clots in Special Populations

There is a lack of high-quality evidence on the comparative effectiveness and safety of techniques to prevent venous thromboembolism (VTE) in special populations, including patients hospitalized with trauma, traumatic brain injury, burns, or liver disease; those on antiplatelet therapy; and those who are obese or underweight, according to a new review from AHRQ's Effective Health Care Program. VTE affects an estimated 900,000 Americans every year, resulting in significant morbidity and mortality. Given that clinical trials typically exclude or do not report on these populations, more high-quality observational research on VTE prevention in special populations is needed and such research should control for confounding variables, such as provider and practice patterns and disease severity. These findings can be found in the full research review, Pharmacologic and Mechanical Prophylaxis of Venous Thromboembolism Among Special Populations.

7. AHRQ Review of Local Therapies for Hepatocellular Carcinoma Finds Insufficient Evidence for Comparison

Insufficient evidence exists to draw conclusions about effectiveness, outcomes, and adverse events across most of the local hepatic therapies studied to treat unresectable primary hepatocellular carcinoma, according to a new research review by AHRQ. Moderate strength of evidence demonstrates that radiofrequency ablation improves overall survival at 3 years compared with percutaneous ethanol or acetic injections. However, more research is needed, especially considering the relatively low percentage (20 percent) of patients who are candidates for surgery and the expected increase in worldwide mortality rates from this form of cancer. These findings are available in the research review, Local Therapies for Unresectable Primary Hepatocellular Carcinoma.

8. AHRQ in the Professional Literature

Meyerhoefer CD, Zuvekas SH, Manski R. The demand for preventive and restorative dental services. Health Econ 2013 Jan 24. Select to access the abstract on PubMed®.

Vashi AA, Fox JP, Carr BG, et al. Use of hospital-based acute care among patients recently discharged from the hospital. JAMA 2013 Jan 23-30; 309(4):364-71. Select to access the abstract on PubMed®.

D'Arcy LP, Stearns SC, Domino ME, et al. Is geriatric care associated with less emergency department use? J Am Geriatr Soc 2013 Jan; 61(1):4-11. Select to access the abstract on PubMed®.

Jung HY, Meucci M, Unruh MA, et al. Antipsychotic use in nursing home residents admitted with hip fracture. J Am Geriatr Soc 2013 Jan; 61(1):101-6. Select to access the abstract on PubMed®.

Haggstrom DA, Klabunde CN, Smith JL, et al. Variation in primary care physicians' colorectal cancer screening recommendations by patient age and comorbidity. J Gen Intern Med 2013 Jan; 28(1):18-24. Select to access the abstract on PubMed®.

Crowley MJ, Grubber JM, Olsen MK, et al. Factors associated with non-adherence to three hypertension self-management behaviors: preliminary data for a new instrument. J Gen Intern Med 2013 Jan; 28(1):99-106. Select to access the abstract on PubMed®.

Spindler KP, Parker RD, Andrish JT, Kaeding CC, Wright RW, Marx RG, et al. Prognosis and predictors of ACL reconstructions using the MOON cohort: a model for comparative effectiveness studies. J Orthop Res 2013 Jan; 31(1):2-9. Select to access the abstract on PubMed®.

Deily ME, Hu T, Terrizzi S, et al. The impact of health information technology adoption by outpatient facilities on pregnancy outcomes. Health Serv Res 2013 Feb; 48(1):70-94. Select to access the abstract on PubMed®.

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Current as of June 2013
Internet Citation: MRSA Study Slashes Deadly Infections in Sickest Hospital Patients: Electronic Newsletter, Issue 382. June 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/newsletters/e-newsletter/382.html