Universal decontamination in the intensive care unit (ICU) has led to success in reducing bloodstream infections and infections with multi-drug resistant organisms. In this cluster-randomized trial of 53 hospitals, a similar protocol of universal decontamination using daily chlorhexidine bathing, as well as the administration of muciprocin for known methicillin-resistant staph aureus (MRSA) carriers, was investigated for its effects on infection due to multi-drug resistant organisms in non-critical-care units, as compared to routine bathing. Hospitals were randomized to deliver routine care or daily chlorhexidine bathing for all patients plus mupirocin for known MRSA carriers. The 194 non-critical-care units in 53 hospitals in the study, patients (n=156,889) were followed for infection rates, specifically for MRSA and vancomycin-resistant enterococcus (VRE). Researchers found that the chlorhexidine and muciprocin intervention led to a significant decrease in multi-drug resistant organism infections, as compared to the baseline period before the intervention (HR 0.79, 95% CI 0.73 to 0.87). However, the routine care group also saw a significant decrease in these infections, as compared to the baseline period (HR 0.87, 95% CI 0.79 to 0.95). No significant difference in effect was found between the two interventions (p=0.17). Investigators therefore concluded that daily chlorhexidine bathing, along with muciprocin for MRSA carriers, was not associated with lower multi-drug resistant organism infection rates, as compared to usual bathing.
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