Regional efforts to curb multidrug-resistant organisms (MDROs) in long-term care facilities and other healthcare settings was linked to fewer cases, hospitalizations and deaths, as well as reduced costs, according to a new study published April 1 in JAMA.
Data on the organisms came from 35 healthcare facilities in California; 16 were nursing homes, 16 were hospitals and three were long-term acute care hospitals. The interventions that helped included leave-on chlorhexidine bathing cloths and rinse-off chlorhexidine liquid for showering when people were admitted and then routinely after.
At nursing homes and long-term acute care hospitals, residents/patients also took nasal iodophor (10% povidone-iodine) twice a day for five days when they were admitted, and on Monday through Friday every other week. In hospitals, the staff received refresher training for universal chlorhexidine bathing in intensive care units (ICUs) and targeted decolonization for all non-ICU patients in contact precautions (CP). The researchers compared data from those who got the intervention to data from one hospital and two nursing homes that withdrew from the experiment. The interventions were put in place between 2017 and 2019.
The prevalence of MDRO dropped from 63.9% to 49.9% among nursing homes, from 80% to 53.3% in long-term acute care hospitals, and from 64.1% to 55.4% in hospitals. The rate of infection-related hospitalizations from nursing homes per 1,000 resident-days changed from 2.31 at the start of the intervention to 1.94 during it, and from 1.90 to 2.03 in nursing homes that didn’t participate.
Compared with hospitals, nursing homes and long-term acute care hospitals stuck to the decolonization protocol better and had greater reductions in MDRO prevalence and incident clinical cultures.
“This greater benefit could be due, in part, to greater adherence from universal vs targeted decolonization and longer lengths of stays of nursing home residents and long-term acute care hospital patients, which provide more time for decolonization to accrue effects and reduce importation of new pathogens due to less frequent turnover,” the authors wrote.
Hospitalization costs linked to infections per 1,000 resident-days declined from $64,651 to $55,149 due to nursing homes that participated, and increased from $55,151 to $59,327 as a result of nursing homes that didn’t take part in the intervention.
