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Revolutionizing Infection Control: The Impact of a Broad Decolonization Program in Southern California Healthcare Facilities

A decolonization program conducted in Southern California, across a network of healthcare facilities, has significantly diminished the prevalence of multidrug-resistant organisms (MDROs) on patients’ skin, according to findings disclosed in the Journal of American Medical Association (JAMA). The program extended to 35 healthcare centers, which included 16 hospitals, 16 nursing homes, and 3 long-term acute care hospitals (LTACHs), with over 50,000 patients participating. The intervention involved routine bathing using an antiseptic soap, alongside an antiseptic nasal ointment. Subsequently, not only was the overall MDRO colonization reduced, it also reduced subsequent infections, hospitalizations, hospitalization-related costs, and deaths.

The research was supported by the Centers for Disease Control and Prevention (CDC). As a result of the 25-month intervention, the researchers estimate that approximately 800 hospitalizations and 60 deaths were prevented. The study’s co-author, Dr. Susan Huang from the University of California Irvine School of Medicine, emphasized the significance of these findings. She expressed elation at the ‘cascade of effects’ this intervention had on reducing MDRO colonization and its associated complications within interconnected healthcare facilities. In the first phase of the research, a simulation model identified decolonization as the most impactful strategy. In the intervention’s second phase, facilities with the most shared patients were identified through networking analysis for the program’s implementation.

The hallmark of this research was acknowledging that MDROs are not confined within a single healthcare facility’s walls. Instead, they are transferred via patients, moving between different facilities, thereby contributing to the spread of drug-resistant bacteria that can infect others. Furthermore, colonization endangers patients themselves, as their chances of infection increase if they have to undergo surgery or have a medical device installed. Chlorhexidine-containing products and nasal iodophor were utilized for patient decolonization during the intervention.

The products’ effectiveness against several resistant pathogens causing healthcare-associated infections, such as methicillin-resistant Staphylococcus aureus (MRSA), has been validated in previous research. The intervention’s success was measured relative to the pre-intervention period. The most substantial reduction in MDRO colonization was observed in nursing homes and LTACHs. Notably, the prevalence of MDROs dropped from 63.9% to 49.9% and 80% to 53.3% respectively. Dr. Huang stated the intervention not only helped reduce MDRO prevalence but also decreased MDRO-positive clinical cultures.

This decolonization strategy’s application accentuates the importance of implementing such regional efforts against antibiotic-resistant bacteria. The CDC encourages a regional focus, underscoring the benefit of preventing germ spread at the facility level, which in turn impacts the entire regional healthcare network. This research asserts the significance of coordinating MDRO control efforts across a patient-sharing network while emphasizing the advantage of centralizing such endeavors around long-term care facilities (LTCFs). As the development of new antibiotics lags behind the emergence and spread of MDROs, prevention is becoming increasingly crucial in managing the risk associated with these infections.

Source: https://www.cidrap.umn.edu/antimicrobial-stewardship/regional-decolonization-effort-linked-fewer-infections-deaths-multidrug

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