The research published in Thursday's New England Journal of Medicine compared three types of ICU infection prevention strategies at 43 hospitals owned by the Hospital Corporation of America. The protocol with the greatest success—universal decolonization with chlorhexidine baths and nasal mupirocin—showed 44% reduction of bloodstream infections. But that strategy is practiced in very few hospitals around the country.
The strategy with the poorest results, screening and isolating those patients infected, is actually commonplace at most hospitals around the country, including those in the VA Healthcare system, and is required by laws in California, Illinois, Nevada, Washington, Minnesota, South Carolina, Pennsylvania, Maine and New Jersey.
Now, however, infection prevention officials for hospitals in those states must consider their own practices and determine whether, in addition to state-mandated ICU screening, isolation and contact precautions—and its considerable costs—they should also start treating all ICU patients with chlorhexidine baths and mupirocin as well to maximize infection reduction.
That's going to be a terrible expense for hospitals in states that mandate screening, Wright says. But he cautions, "don't stop screening, because you'd be really setting yourself up for nothing more than trouble when the state comes to visit."