A decolonization protocol that has reduced infections in ICU patients did not translate that overall efficacy when researchers tried it on non-critical care patients. However, when they targeted non-ICU patients with central and other lines in place, they saw MRSA and VRE infections drop by one-third.
The decolonization protocol included using chlorhexidine for routine daily bathing, as well as mupirocin in the nares twice daily for five days.1 However, the intervention had little impact on ward patients and the infection rates were not significantly different from the control arm that continued standard care.
“This finding led us to ask the question, ‘If it is not beneficial in the overall population, are there subsets of higher-risk patients for which decolonization might be beneficial?’” said Susan Huang, MD, MPH, director of epidemiology and infection prevention at the University of California, Irvine School of Medicine.
Presenting the findings recently in San Diego at the IDWeek conference, Huang reported decolonization benefits were realized when they broke down the data and looked only at patients with lines. “Looking at patients with central lines, midlines, and lumbar drains, we found a significant 32% reduction in MRSA and VRE clinical cultures,” she said. “These patients accounted for only 12% of the entire study population, but they were responsible for over a third [of infections].”
The study randomized 53 hospitals in 15 states to a control arm or intervention protocols.
“We didn’t see an overall impact for house-wide decolonization, unlike what we have seen in ICU trials,” Huang said. “It is very likely that these are lower-risk patients (overall). But we do report a very large and significant benefit in the higher-risk patients who had devices.”
- Huang S, Septimus E, Kleinman K, et al. Daily Chlorhexidine Bathing in General Hospital Units – Results of the ABATE Infection Trial (Active BAThing to Eliminate Infection) Abstract 1000. IDWeek 2017. Oct. 4-8, 2017. San Diego.