Landmark UCI study in the New England Journal of Medicine highlights how adults can prevent infection with MRSA bacteria after hospital discharge

Large clinical trial shows that antiseptic soap, mouthwash, and nose ointments prevent post-discharge MRSA infections and hospitalizations

Hospital patients who have methicillin-resistant Staphylococcus aureus (MRSA) can be protected from future infections with a standard bathing regimen at home or in a nursing home after hospital discharge, according to a University of California, Irvine researcher and colleagues. The paper, “Decolonization to Reduce Post-discharge Infection Risk among MRSA Carriers,” is published in the Feb. 14 issue of the New England Journal of Medicine. Adults with MRSA who used topical over-the-counter antiseptic soap for showering or bathing, plus prescription mouthwash and a nasal ointment experienced a 30 percent reduction in subsequent MRSA infections and hospitalizations. 

“These results show that we can help protect thousands of patients who have MRSA from serious infections after they leave the hospital,” said Susan Huang, MD, MPH, the study’s lead author and professor in the Division of Infectious Diseases, UCI School of Medicine. 

“Currently, patients who have MRSA somewhere on their body have a 1 in 4 risk of developing a serious infection in the year after discharge, and 1 in 10 will develop a new MRSA infection,” Huang said. “Nearly all of these infections will require re-hospitalization. We have found a way to help prevent them.” 

The clinical trial, called Project CLEAR (Changing Lives by Eradicating Antibiotic Resistance), involved 2,121 adults who were assigned randomly into two groups: the education-only group and the education plus decolonization group. Patients whose bodies harbor MRSA are said to be “colonized.” 

The education-only group received education about MRSA and information about cleaning and laundering to prevent MRSA in the home. The education plus decolonization group received the same education, but also were given a five-day decolonization treatment regimen to remove MRSA. This decolonization treatment regimen included regular bathing or showering with over-the-counter chlorhexidine soap, rinsing with prescription chlorhexidine mouthwash, and treating the nose with prescription mupirocin ointment. This group used the “decolonization” regimen twice a month for six months after hospital discharge. 

Patients in the education plus decolonization group were protected from infections and repeat hospitalizations as compared to the education-only group. The education plus decolonization group had a 30 percent reduction in repeat MRSA infection and 17 percent fewer infections from any type of germ as compared to the education-only group. Patients who did not miss any doses experienced 44 percent fewer MRSA infections and 40 percent fewer infections from all germs. 

“We have made great advances in preventing infections during hospital stays,” Huang said. “Now we have a proven strategy to prevent infections even after hospital discharge.”

In its 2013 report, Antibiotic Resistance Threats in the United States, the Centers for Disease Control and Prevention (CDC) estimates that at least two million illnesses and 23,000 deaths are caused annually by antibiotic-resistant bacteria, including MRSA, in the United States. The Institute for Healthcare Improvement has estimated that the total cost burden to the U.S. health care system from MRSA infections is more than $2.5 billion annually.

“Most serious healthcare-associated MRSA infections occur following discharge from a hospital and to date we have had few available prevention strategies that specifically address this high-risk period,” said John Jernigan, MD, MS, director of CDC’s Office of Prevention Research and Evaluation and head of CDC’s Prevention Epicenters Program. “This novel intervention, initiated at the time a patient is being discharged from the hospital, helps fill this gap, and provides an important addition to our toolbox for fighting these difficult-to-treat infections.” 

Project CLEAR was supported by a grant (R01HS019388, to Dr. Huang) from the AHRQ Healthcare-Associated Infections Program, and by the UCI’s Institute for Clinical and Translational Science, which was funded by a grant from the NIH Clinical and Translational Sciences Award program (UL1 TR000153). 

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