Decolonization reduces hospitalization rates in nursing home residents

1. In this randomized controlled trial, universal decolonization with topical antiseptics significantly reduced the risks of hospitalization due to infection among nursing home residents as compared to routine care. 

2. The number needed to treat (NNT) was 9.7 to prevent one hospitalization due to infection in the nursing home setting.

Evidence Rating Level: 2 (Good)

Study Rundown: Healthcare-associated infections are a major cause of death among nursing home residents, arising from many sources and affecting a particularly medically vulnerable population. Furthermore, the nursing environment is also prone to the development and spread of multidrug-resistant organisms. Decolonization has been shown in other healthcare settings to reduce the risk of nosocomial infections. This study was a cluster-randomized trial the evaluate universal decolonization against routine-care bathing in nursing homes to prevent infection-related hospitalization. The decolonization group received chlorhexidine for bathing or showering and nasal iodophor for nasal decolonization, whereas the control group underwent routine bathing and showering practices. The intervention group saw a significant reduction in risks of hospitalization due to infection and for any reason. The NNT was 9.7 and 8.9, respectively, to prevent one infection-related hospitalization and one hospitalization for any reason. Although the study was limited by implementation and adherence challenges due to a lack of support and administrative policies, these results demonstrated that universal decolonization mitigated the risk of infection-related hospitalization among nursing home residents.

Click here to read the study in NEJM

In-Depth [randomized controlled trial]: The current study was a cluster-randomized trial to assess the impact of universal decolonization compared to routine-care bathing on hospitalizations due to infection in nursing homes. Nursing homes providing skilled nursing care in Los Angeles and Orange counties in California were eligible for inclusion. Nursing homes were excluded if they were only providing pediatric, dementia, or psychiatric care, or if they already practiced routine decolonization. In total, 28 nursing homes with 28,956 residents were enrolled in the study and each underwent an 18-month baseline period and an 18-month intervention period. During the intervention period, the nursing homes were randomized to the decolonization group, where residents received chlorhexidine-based bathing or showering and iodophor nasal decolonization, or the control group, where residents underwent routine-care bathing and showering practices with no nasal decolonization. The primary outcome was transfer to hospital due to infection, as a proportion of hospitalizations. The control group reported similar rates of infection-related hospitalization during the baseline period (62.2%) and the intervention period (62.6%; Risk Ratio [RR], 1.00; 95% Confidence Interval [CI], 0.96-1.04). Conversely, the decolonization group’s infection-related hospitalization rate declined from 62.9% during the baseline period to 52.2% in the intervention period (RR, 0.83; 95% CI, 0.79-0.88), which was a difference of 16.6% in RR compared to the control group (95% CI, 11.0-21.8%; p<0.001). The rates of hospitalization for any reason were comparable between the baseline and intervention periods in the control group (RR, 1.08; 95% CI, 1.04-1.12). In summary, these results were generalizable and demonstrated that universal decolonization with topical antiseptics reduced the risk of hospitalization from hospitalization due to infection in nursing homes.

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