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Decolonization in Nursing Homes to Prevent Infection and Hospitalization.

Loren G Miller1, James A McKinnell1, Raveena D Singh1

  • 1From the Division of Infectious Diseases, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance (L.G.M., J.A.M., J. Mendez, J.F., R.F., G.T., A.M., C.T.), the Division of Infectious Diseases (R.D.S., G.M.G., R.S., T.D.C., J.C., L.H., T.T., S.P., S.K.G., M.E., B.L., J.H., E.L., C.N., J.L., S.A., S.S.H.) and the Department of Pathology and Laboratory Medicine (J.A.S., K.D.E., C.E.B.), University of California Irvine School of Medicine, Irvine, the Division of Geriatrics and Gerontology, University of California Irvine School of Medicine, Orange (S.T.), the California Association of Health Facilities, Sacramento ( J. Montgomery, D.W.), and Hoag Memorial Hospital, Newport Beach (P.A.R.) - all in California; the Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst (K.K., S.G.S.); the Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta (N.D.S.); the Society for Post-Acute and Long-Term Care Medicine, Columbia, MD (K.S., E.P.); the National Association of Directors of Nursing Administration in Long-Term Care, Springdale, OH (N.B.); and the Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, South Korea (E.L.).

The New England Journal of Medicine
|October 10, 2023
PubMed
Summary
This summary is machine-generated.

Universal decolonization in nursing homes significantly reduced hospital transfers due to infection. This infection control strategy using chlorhexidine and povidone-iodine proved effective in a large resident population.

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Area of Science:

  • Infectious Disease Epidemiology
  • Geriatric Care
  • Public Health Interventions

Background:

  • Nursing home residents face elevated risks of infection, hospitalization, and multidrug-resistant organism colonization.
  • Effective infection control strategies are crucial for this vulnerable population.

Purpose of the Study:

  • To evaluate the efficacy of universal decolonization in reducing hospital transfers due to infection among nursing home residents.
  • To compare universal decolonization with routine bathing care.

Main Methods:

  • A cluster-randomized trial was conducted over 36 months (18-month baseline, 18-month intervention).
  • Universal decolonization involved chlorhexidine bathing and nasal povidone-iodine application.
  • Generalized linear mixed models were used for intention-to-treat analysis of infection-related and all-cause hospital transfers.

Main Results:

  • The decolonization group showed a 16.6% lower risk ratio for infection-related hospital transfers compared to routine care (P<0.001).
  • All-cause hospital transfers were reduced by 14.6% in the decolonization group versus routine care.
  • The number needed to treat was 9.7 for infection-related hospitalizations and 8.9 for all hospitalizations.

Conclusions:

  • Universal decolonization with chlorhexidine and nasal iodophor significantly lowers the risk of infection-related hospital transfers in nursing homes.
  • This intervention represents a promising approach to enhance patient safety and reduce healthcare utilization in long-term care facilities.