Decolonization Protocol in Facilities that Share Patients Saves Lives, Dollars

April 18th, 2024

A regional decolonization collaborative among hospitals and long-term care facilities that commonly share patients led to decreased infections, hospitalizations, costs, and deaths caused by multidrug-resistant organisms (MDROs), researchers reported.

“Over the course of about 25 months, we prevented what was estimated to be 800 hospitalizations and 60 deaths. [That is just] from the nursing homes,” says lead investigator Susan Huang, MD, MPH, medical director of epidemiology and infection prevention at the University of California, Irvine.

Whereas the protocol was universal in the long-term care settings, hospital patients included in the study already were under contact precautions for MDROs and, of course, had shorter lengths of stay. “They have shorter stays, so we’re lucky if we could finish the decolonization protocol before they were discharged,” she says. “The benefit is probably gained elsewhere.”

Since all facilities shared patients, a benefit anywhere may move across the continuum to help another facility. The 35 participating facilities included 16 hospitals, 16 nursing homes, and three long-term acute care hospitals (LTACHs) in Orange County, CA.

The protocol used chlorhexidine bathing and nasal iodophor antisepsis (10% povidone-iodine) for residents in long-term care and hospitalized patients in contact precautions.

“The intervention involved universal decolonization in nursing homes and LTACHs using 2% leave-on chlorhexidine-impregnated cloths for bed bathing, and 4% rinse-off chlorhexidine liquid for showering on admission and routinely thereafter,” the authors reported. “Additionally, all nursing home residents and LTACH patients received twice-daily nasal iodophor for five days on admission and then Monday through Friday, every other week.”

Hospitals received refresher training for ongoing universal chlorhexidine bathing in intensive care units (ICUs) and adopted targeted decolonization for all non-ICU patients in contact precautions.

“Targeted decolonization involved five days of chlorhexidine baths and twice daily nasal iodophor,” the authors noted. “Residents in nursing homes generally received a bath or shower three times per week, while patients in LTACHs or hospitals were generally offered a daily bath or shower.”

Prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and extended spectrum beta-lactamase (ESBLs) significantly decreased in nursing homes and LTACHs. Decolonization was associated with a 27% reduction in infection-related hospitalization costs. The study was conducted from July 1, 2017, to July 31, 2019.

For more on this story, see the next issue of Hospital Infection Control & Prevention.

Gary Evans, BA, MA, has written numerous articles on infectious disease threats to both patients and healthcare workers for more than three decades. He has been honored for excellence in analytical reporting five times by the National Press Club in Washington, DC.