Reducing Hospitalizations and Multidrug-Resistant Organisms via Regional Decolonization in Hospitals and Nursing Homes
US study found universal decolonisation (chlorhexidine bathing and nasal decolonisation) for long-term care residents & hospitalised patients in contact precautions was associated with lower MDR organism prevalence and decreased infection-related hospitalisations and deaths.
Source:
Journal of the American Medical Association
SPS commentary:
The intervention was implemented in 16 hospitals and 19 long-term care facilities (LTCF) in California. It involved twice-weekly application of an intranasal iodophor for 5 days every other week combined with routine bathing using a chlorhexidine-containing product for all residents in participating LTCFs, but only those in hospital who were undergoing contact precautions. After implementation, multi-drug resistant organism colonisation was reduced in long-term acute care hospitals (OR 0.67; 95% CI 0.50-0.89), in skilled nursing facilities (0.77; 95% CI 0.69-0.86), and in hospitals (0.86; 0.75-0.98) compared with baseline. For nursing homes, the rate of infection-related hospitalisations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among those participating in the intervention, and from 1.90 to 2.03 among nonparticipating nursing homes (group × period interaction reduction, 26.7%; 95% CI, 19.0%-34.5%).
An accompanying editorial discusses the limitations of the study, including the costs and added staff time, and how the relative contributions of intranasal iodophor application and bathing using chlorhexidine are not clear. They comment that given the uncertainties around cost benefit and causal mechanisms, additional studies are needed before widescale adoption of the intervention used in the study can be recommended.