Antiseptic soap and nasal decolonization can prevent infection and hospitalization among nursing home residents — a simple intervention more facilities should use, Susan Huang, MD, the medical director of epidemiology and infection prevention at UC Irvine in California, wrote in a commentary published Monday.
“Many of our currently available interventions to prevent the spread of multidrug-resistant organisms (MDROs) and MDRO infections are costly and challenging to implement, which can limit their effectiveness, particularly in the nursing home setting,” Huang wrote in Medscape.
But recent interventions supported with data from 28 nursing homes as part of the PROTECT trial can give facilities simple ways to reduce infections. In the trial, 14 facilities received usual care and the other 14 underwent universal decolonization. This included bathing and showering residents with chlorhexidine antiseptic soap about three times a week, and applying nasal swabs with 10% povidone-iodine (iodophor) twice daily for five days for all new residents, and then twice daily Monday through Friday every other week for all residents.
Compared to those who underwent usual care, among residents who received universal decolonization, the rate of infection as a cause for being hospitalized went down by 17%. Rates of discharge from a nursing home to a hospital decreased by 15%. For a typical nursing home with 100 residents, where approximately 10.5 residents are hospitalized each month for any reason, universal decolonization prevented 1.9 infection-related hospitalizations per month with all beds filled.
Decolonization intervention also reduced multidrug-resistant organisms (MDRO) prevalence by 30%. This included a 27% reduction in methicillin-resistant Staphylococcus aureus, a 50% reduction in extended-spectrum beta-lactamase producers, and a 71% reduction in vancomycin-resistant Enterococcus.
“Research staff provided nursing home leaders with educational materials, and supported training, feedback, and encouragement. Because of this, it would be reasonable to expect that nursing homes that dedicate leadership oversight to implementing the universal decolonization strategy as an important campaign can see similar results with training, monitoring, feedback, and encouragement,” Huang wrote.Huang noted that a free toolkit with protocols, training materials, posters and frequently asked questions is available to download.
