Routine chlorhexidine bathing and targeted use of mupirocin dramatically reduced methicillin-resistant Staphylococcus aureus (MRSA) infections in non-ICU patients with invasive devices like central lines, researchers report.
In the ABATE Infection (Active Bathing to Eliminate infection) trial, patients at 53 hospitals were routinely bathed with chlorhexidine and given targeted nasal mupirocin in non-critical-care units. “Hospitals were randomized and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known [MRSA] carriers,” the authors reported.1
“The primary outcome was MRSA or vancomycin-resistant Enterococcus clinical cultures attributed to participating units.”
In this continuing trial, the use of chlorhexidine bathing and nasal mupirocin has previously proven effective at preventing infections in ICU patients. Researchers extended the practice to see whether non-ICU patients would benefit. General patients showed no benefit, but the practice demonstrated efficacy in a subset of this population: non-ICU patients with medical devices.
“That is the main takeaway from this trial,” says lead author Susan Huang, MD, of the infectious disease and health policy departments at the University of California, Irvine. “It was not beneficial in a uniform way in the non-ICU patients, but it was in this high-target group of people with devices.”
The finding makes sense given that devices and invasive lines can seed infections in non-ICU patients. The HCA Healthcare System is sufficiently convinced that it is implementing the practice in all its hospitals.
“One of the most important and intriguing findings in the trial was that people with medical devices are only 10% of the non-ICU population, but they [account for] more than 50% of all the BSIs [bloodstream infections] that occur outside of the ICU,” Huang says.
In the study, non-ICU patients with central lines and lumbar drains had a 30% reduction in BSIs.
“I think the most common reason why we did not find a benefit in the overall non-ICU population is that they are at much, much less risk of infection,” Huang says.
“I think that’s why when you look at the subgroup of those with devices, the story makes much more sense. This little group is disproportionally responsible for very serious and well-known HAIs. For that reason, I think it gives credence to do something in a targeted fashion.”
- Huang SS, Septimus E, Kleinman K, et al. Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomized trial. Lancet 2019;393:1205-1215.