A groundbreaking randomized trial, featured in the New England Journal of Medicine, has unveiled promising outcomes for the implementation of a universal decolonization strategy within nursing homes.
This strategy involves systematically cleansing the skin and nasal passages of nursing home residents and has shown significant potential to reduce infection-related hospitalizations and the prevalence of multidrug-resistant organisms (MDROs) among this vulnerable population.Â
The study, known as the Protect Trial, was conducted across 28 nursing homes in California. In this trial, half of the nursing homes adopted the decolonization strategy, while the other half adhered to their standard bathing routines. The decolonization approach entailed regular bathing and showering using chlorhexidine gluconate (CHG) soap and nasal swabbing with nasal iodophor antiseptic.
These procedures occurred twice daily, five days a week, every other week. The findings are nothing short of remarkable. Nursing homes that embraced the decolonization strategy experienced a significant reduction in infection-related hospitalizations in comparison to those that adhered to traditional routines.
The percentage of hospital transfers linked to infections plummeted from 62.9% to 52.2% in the decolonization group, while the control group saw minimal change, remaining at 62.6%. Moreover, rates of all-cause hospitalizations also decreased in the decolonization group, from 35.5% to 32.4%, while the control group exhibited an increase from 36.6% to 39.2%.Â
The decolonization approach further exhibited positive effects on the prevalence of MDROs among nursing home residents. In the decolonization group, MDRO colonization decreased significantly, dropping from 48.9% to 32%. In contrast, the control group only experienced a marginal decrease from 48.3% to 47.2%. Remarkably, this reduction was observed across various MDROs, including MRSA and vancomycin-resistant Enterococci.Â
The potential impact of this relatively straightforward intervention on the safety and well-being of nursing home residents cannot be overstated. Extrapolating the data, the researchers estimate that implementing the decolonization strategy in a 100-bed nursing home could prevent two infection-related hospitalizations per month. Importantly, the implications of this study extend far beyond nursing homes.
These facilities often serve as crucial links in the healthcare chain, facilitating the movement of patients between hospitals and long-term acute care facilities, which can inadvertently foster pathogen transmission. The widespread adoption of the decolonization strategy in healthcare facilities could significantly mitigate the risk of drug-resistant infections, ultimately benefiting the entire healthcare community.Â
In summary, the universal decolonization strategy has emerged as a promising intervention in the battle against infection-related hospitalizations and MDRO prevalence within nursing homes. Its potential to enhance the quality of care for this vulnerable demographic and contribute to broader efforts to combat drug-resistant infections in healthcare settings cannot be understated. Â
Journal ReferenceÂ
Miller, L. G., McKinnell, J. A., Singh, R. D., Gussin, G. M., Kleinman, K., Saavedra, R., … Huang, S. S. (2023). New England Journal of Medicine. doi:10.1056/nejmoa2215254Â
