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Decolonization and decontamination: what's their role in infection control?
1Institute for Infection and Immunity, Paediatric Infectious Diseases Research Group, St. Georges University of London, London, UK.
Insights
Decolonization and decontamination show limited evidence in children for reducing hospital-acquired infections and antimicrobial resistance. More research is needed for effective pediatric and neonatal strategies, especially in resource-poor settings.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Antimicrobial Stewardship
Background:
- Hospital-acquired infections (HAIs) are a significant concern in pediatric patients, contributing to antimicrobial resistance.
- Standard infection control measures are crucial but may require adjunct strategies.
Purpose of the Study:
- To review the efficacy of decolonization and decontamination interventions in hospitalized children and neonates.
- To evaluate these strategies as adjuncts to standard infection control.
Main Methods:
- Literature review of studies on decolonization and decontamination in pediatric populations.
- Analysis of evidence regarding specific interventions like chlorhexidine washes, nasal mupirocin, and digestive tract decontamination.
Main Results:
- Limited evidence exists for decolonization and decontamination in children, with some studies showing uncertain or negative results (e.g., oral chlorhexidine).
- Evidence for chlorhexidine washcloths and digestive tract decontamination is based on few studies, with applicability to neonates and resource-poor settings being unclear.
- Nasal mupirocin efficacy for MRSA in neonates is uncertain.
Conclusions:
- Robust evidence for decolonization and decontamination efficacy is lacking in pediatric patients, unlike in adults.
- Urgent need for research to adapt these interventions for neonates and resource-limited settings to combat high HAI prevalence.
Purpose Of Review:
Hospital-acquired infections cause up to 19% of infections in paediatric patients contributing to the spread of antimicrobial resistance. This review evaluates the effect of decolonization and decontamination in hospitalized children and neonates as an adjunct to standard infection control measures.
Recent Findings:
Few studies on decolonization and decontamination are available in children. The evidence about the effectiveness of daily chlorhexidine washcloths on bacteraemia in paediatric patients relies on a single randomized controlled trial, in neonates with central venous access in a single retrospective observational study. It is uncertain whether nasal mupirocin reduces methicillin-resistant Staphylococcus aureus carriage and infections in neonates, whereas oral chlorhexidine mouthwashes have not proven effective in children in intensive care settings. Scanty evidence demonstrates a reduction in the rate of ventilation-acquired pneumonia with digestive tract decontamination in paediatric patients and no studies are available in neonates. These strategies have not been extensively tested in resource-poor countries.
Summary:
Strong evidence about the efficacy of decolonization and decontamination interventions exists in adult medicine but not in paediatric patients. There is an urgent need to understand how these interventions could be adapted to neonates and resource-poor settings in which the prevalence of hospital-acquired infections is higher.
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