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Antiseptic Intervention Proves Effective in Reducing Multidrug-resistant Infections in Orange County Healthcare Facilities: The SHIELD-OC Study

In a novel strategy against multidrug-resistant organisms, a county-wide decolonization intervention conducted in nursing homes and selected hospital patients across Orange County, California, successfully reduced rates of infection, hospitalization, and deaths. This is according to the SHIELD-OC study, which utilises a proactive approach to curb multidrug-resistant organism (MDRO) prevalence among these healthcare facilities.

The study utilized two primary interventions, namely chlorhexidine bathing and nasal iodophor antisepsis. The measures adopted led to significant decreases in the prevalence of MDROs compared to non-participating facilities. The reduction was considerable, with infection-related hospitalization decreased by an estimated 26.7% among participating nursing homes compared to the facilities not included in the study. This outcome parallels the 31% reduction observed in the PROTECT trial, a separate investigation that assessed the efficacy of universal chlorhexidine and nasal iodophor intervention in nursing homes.

The study further revealed that the adoption of decolonization was correlated with a 23.7% cutback in fatalities from infection-related hospitalizations among nursing homes included in the study. The resultant statistics enthused researchers, boasting significant reductions across the county with substantial decline in hospitalizations and deaths among nursing home residents.

Given their cost-effectiveness and proven efficiency, there has been a call for health insurers to consider incentivizing hospitals and nursing homes to adopt these quality improvement strategies. The adoption could result in significant cost-savings from reduced hospitalizations, likely exceeding the expense of antiseptic soap and nasal ointment.

The study also emphasized the need for an expanded focus beyond just hospital settings, given that long-term care facilities (LTCFs) often battle higher colonization rates. The consistency of intervention application appears to be a key component contributing to higher adherence rates contributing to the intervention’s success.

The SHIELD-OC quality improvement study, conducted from July 2017 to July 2019, involved 35 facilities in Orange County, implementing interventions such as twice-daily nasal iodophor applications and routine bathing with chlorhexidine. Proponents argue that even minimum routinization of such practices among LTCFs can significantly slash resident risks for MDRO colonization.

Still, it remains challenging to contrast the relative benefits of intranasal iodophor application or chlorhexidine bathing due to lack of detail on control facilities’ bathing practices. While the study provides promising leads, further investigation would be beneficial in understanding the specific influence of these individual interventions.


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