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A Step Forward in Infection Prevention in Nursing Homes: The Impact of a Universal Decolonization Strategy

In the milieu of healthcare infections, geriatric care facilities, or nursing homes, represent a significant area of concern. They house vulnerable populations with age and illness amplifying the risk for infections, including those caused by multidrug-resistant organisms (MDROs). A randomised trial has offered encouraging results, establishing how a universal decolonization regimen can significantly reduce infection-related hospitalizations among nursing home residents.

The New England Journal of Medicine published the trial results, spotlighting an intervention that left its mark by dramatically bringing down not only all-cause hospitalization but also MDRO prevalence. This landmark trial underscores the efficacy of a simple bathing routine for decolonization, already adopted in hospital ICUs for bacterial infection-curbing and now revealing its great potential in nursing home settings. Annually, nursing homes see roughly three million healthcare-associated infections (HAIs) resulting in 150,000 hospital admissions and tragically, 350,000 deaths. The frequency of MDROs in nursing homes eventuates to be quadruple that in hospitals.

Nimalie Stone, MD, MS, associated with the CDC’s Division of Healthcare Quality Promotion, perceives this intervention as invaluable. It could shield the elder population from infections. The challenges that hospitalizations pose to the physical and emotional wellbeing of these residents cannot be understated. The trial, carried out in 28 nursing homes across California, demonstrated the impressive effectiveness of the decolonization strategy (a combination of CHG soap and nasal iodophor use). Reductions in infection-induced hospital transfers and all-cause hospitalizations were observed. A microbiological analysis further validated the strategy’s mettle, highlighting a decline in MDRO colonization. It’s estimated that executing this approach in a 100-bed nursing home may thwart two infection-induced hospitalizations monthly.

This represents a noteworthy win for the healthcare system, easily achievable and crucially significant. The reverberations of such a breakthrough can be felt beyond nursing homes, due to the passage of patients across healthcare facilities. As nursing homes are intermediaries for patients moving from hospitals and long-term acute care facilities to post-discharge care, they inadvertently become hotpots for MDRO transmission.

Therefore, a cross-facility application of the decolonization strategy might just be what the situation entails. Clinical infection prevention might gain multifold from this intervention, making every network stakeholder – residents, personnel and the wider community, safer.


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