Decolonization in Nursing Homes to Prevent Infection and Hospitalization
RCT (28 nursing homes;28,956 residents) found that compared to routine care, use of chlorhexidine for all routine bathing & nasal povidone–iodine (twice daily for first 5 days post admission then same regimen every other week) reduced risk of transfer to hospital due to infection
Source:
New England Journal of Medicine
SPS commentary:
Among the patients given usual care, 62.2% and 62.6% of the transfers to a hospital were due to an infection in the 18-month baseline period and 18-month treatment period respectively (risk ratio [RR] 1.00, 95%CI 0.96-1.04). Values were 62.9% and 52.2% for those given decolonisation (RR 0.83; 95% CI, 0.79 to 0.88), for a difference in RR as compared with routine care, of 16.6% (95% CI, 11.0 to 21.8; P<0.001). In the usual care group, 36.6% of patients were transferred to a hospital for any reason in the baseline period vs 39.2% in the treatment period (1.08, 1.04-1.12). Values were 35.5% and 32.4% for decolonisation (RR 0.92, 0.88-0.96), with a difference in RR of 14.6% (9.7-19.2). The number needed to treat was 9.7 to prevent one infection related hospitalisation and 8.9 to prevent one hospitalisation for any reason.