Reducing Hospitalizations and Multidrug-Resistant Organisms via Regional Decolonization in Hospitals and Nursing Homes

• Published in: JAMA : the journal of the American Medical Association 2024-05, Vol.331 (18), p.1544-1557
• Main Authors: Gussin, Gabrielle M, McKinnell, James A, Singh, Raveena D, Miller, Loren G, Kleinman, Ken, Saavedra, Raheeb, Tjoa, Thomas, Gohil, Shruti K, Catuna, Tabitha D, Heim, Lauren T, Chang, Justin, Estevez, Marlene, He, Jiayi, O’Donnell, Kathleen, Zahn, Matthew, Lee, Eunjung, Berman, Chase, Nguyen, Jenny, Agrawal, Shalini, Ashbaugh, Isabel, Nedelcu, Christine, Robinson, Philip A, Tam, Steven, Park, Steven, Evans, Kaye D, Shimabukuro, Julie A, Lee, Bruce Y, Fonda, Emily, Jernigan, John A, Slayton, Rachel B, Stone, Nimalie D, Janssen, Lynn, Weinstein, Robert A, Hayden, Mary K, Lin, Michael Y, Peterson, Ellena M, Bittencourt, Cassiana E, Huang, Susan S
• Format: Article
• Language: English
• Subjects: Administration, Intranasal; Aged; Anti-Infective Agents, Local - administration & dosage; Anti-Infective Agents, Local - therapeutic use; Bacterial Infections - economics; Bacterial Infections - microbiology; Bacterial Infections - mortality; Bacterial Infections - prevention & control; Bathing; Baths - methods; California - epidemiology; Chlorhexidine; Chlorhexidine - administration & dosage; Chlorhexidine - therapeutic use; Collaboration; Cross Infection - economics; Cross Infection - microbiology; Cross Infection - mortality; Cross Infection - prevention & control; Decolonization; Drug Resistance, Multiple, Bacterial; Fatalities; Health care; Health care facilities; Health Facilities - economics; Health Facilities - standards; Health Facilities - statistics & numerical data; Hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Hospitals; Hospitals - standards; Hospitals - statistics & numerical data; Humans; Infection Control - methods; Infections; Intervention; Iodophors - administration & dosage; Iodophors - therapeutic use; Long term health care; Long-term care; Morbidity; Multidrug resistance; Multidrug resistant organisms; Nurses; Nursing homes; Nursing Homes - economics; Nursing Homes - standards; Nursing Homes - statistics & numerical data; Online First; Original Investigation; Patient Transfer; Patients; Quality control; Quality Improvement - economics; Quality Improvement - statistics & numerical data; Skin Care - methods; Universal Precautions
• ISSN: 0098-7484; 1538-3598; 1538-3598
• DOI: 10.1001/jama.2024.2759

IMPORTANCE: Infections due to multidrug-resistant organisms (MDROs) are associated with increased morbidity, mortality, length of hospitalization, and health care costs. Regional interventions may be advantageous in mitigating MDROs and associated infections. OBJECTIVE: To evaluate whether implementation of a decolonization collaborative is associated with reduced regional MDRO prevalence, incident clinical cultures, infection-related hospitalizations, costs, and deaths. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted from July 1, 2017, to July 31, 2019, across 35 health care facilities in Orange County, California. EXPOSURES: Chlorhexidine bathing and nasal iodophor antisepsis for residents in long-term care and hospitalized patients in contact precautions (CP). MAIN OUTCOMES AND MEASURES: Baseline and end of intervention MDRO point prevalence among participating facilities; incident MDRO (nonscreening) clinical cultures among participating and nonparticipating facilities; and infection-related hospitalizations and associated costs and deaths among residents in participating and nonparticipating nursing homes (NHs). RESULTS: Thirty-five facilities (16 hospitals, 16 NHs, 3 long-term acute care hospitals [LTACHs]) adopted the intervention. Comparing decolonization with baseline periods among participating facilities, the mean (SD) MDRO prevalence decreased from 63.9% (12.2%) to 49.9% (11.3%) among NHs, from 80.0% (7.2%) to 53.3% (13.3%) among LTACHs (odds ratio [OR] for NHs and LTACHs, 0.48; 95% CI, 0.40-0.57), and from 64.1% (8.5%) to 55.4% (13.8%) (OR, 0.75; 95% CI, 0.60-0.93) among hospitalized patients in CP. When comparing decolonization with baseline among NHs, the mean (SD) monthly incident MDRO clinical cultures changed from 2.7 (1.9) to 1.7 (1.1) among participating NHs, from 1.7 (1.4) to 1.5 (1.1) among nonparticipating NHs (group × period interaction reduction, 30.4%; 95% CI, 16.4%-42.1%), from 25.5 (18.6) to 25.0 (15.9) among participating hospitals, from 12.5 (10.1) to 14.3 (10.2) among nonparticipating hospitals (group × period interaction reduction, 12.9%; 95% CI, 3.3%-21.5%), and from 14.8 (8.6) to 8.2 (6.1) among LTACHs (all facilities participating; 22.5% reduction; 95% CI, 4.4%-37.1%). For NHs, the rate of infection-related hospitalizations per 1000 resident-days changed from 2.31 during baseline to 1.94 during intervention among participating NHs, and from 1.90 to 2.03 among nonparticipating NHs (group × p