Decolonization Technique Could Lead to Fewer Nursing Home “Superbug” Infections: Study

Nursing homes and long-term care facilities that implement certain infection protocols should be able to greatly reduce the number of deaths and hospitalizations experienced by residents due to “superbugs”, according to the findings of a new study.

Using chlorhexidine bathing and a nasal swabs helped reduce the prevalence of serious drug-resistant infections by 23% to 30%, and reduced the number of hospitalizations by 27% on average, according to researchers from the University of California Irvine School of Medicine. Their findings were published on April 1 in the Journal of the American Medical Association (JAMA).

Nursing Home Superbug Infection Risks

Elderly and ill individuals face a particularly high risk from so-called “superbug” infections, which are resistant to antibiotics and available treatments, often resulting in lengthy hospitalization, high healthcare costs and an increased risk of death.

Many antibiotic-resistant infections in hospitals and nursing homes are linked to contaminated patient rooms and floors, as well as the overuse of antibiotics and a lack of hand-washing among nursing home patients, health experts warn. As a result, most prevention efforts have focused on solutions like added hand washing, or other antibacterial bathing protocols.

In recent years, the prevalence of antibiotic-resistant bacteria-related infections has been increasing and causes more than 35,000 deaths every year in the U.S., according to health experts.

In this latest study, researchers conducted a collaborative intervention called SHIELD-OC, centered in 35 healthcare facilities in Orange County, California, from 2017 to 2019. They focused on regional hospitals and long-term care nursing home facilities.

The intervention included a semi-experimental infection decolonization procedure to reduce the likelihood of infection and the presence of multidrug-resistant organisms (MDROs), also commonly known as antibiotic-resistant bacteria, or superbugs.

The procedure involved using chlorhexidine bathing and a nasal swab process on nursing home residents. Chlorhexidine is an antiseptic and disinfectant used to help reduce the number of bacteria on the skin and in the nose to prevent infection.

According to the findings, using the infection protocol led to a significantly lower prevalence of antibiotic-resistant bacteria among patients overall. Similarly, infection-related hospitalizations, hospitalization costs, and deaths among nursing home residents also decreased.

The presence of antibiotic-resistant bacteria among patients dropped from 64% to 50% in nursing homes, from 80% to 53% among patients in long-term acute care hospitals, and from 64% to 55% among patients in hospitals, researchers determined.

In addition, infection-related hospitalizations also decreased from 2.31 hospitalizations per 1,000 resident days to 1.94 among nursing homes using the disinfection protocol. Nursing homes that did not use the protocol saw an increase in infection-related hospitalizations, from 1.9 to 2.03 per 1,000 resident days.

Nursing homes that used the infection protocol also experienced a decrease in deaths from 0.29 to 0.25 per 1,000 resident days. Nursing homes that didn’t use the protocol experienced infection-related deaths of 0.23 to 0.24 per 1,000 resident days by the end of the study period, the data indicates.

Hospital costs related to superbugs also dropped among nursing homes using the protocol, from $64,651 to $55,149 per 1,000 resident days. Among nursing homes that didn’t use the protocol, hospitalization costs increased from $55,151 to $59,327 per 1,000 resident days.

Among participating hospitals, the average rate of clinical cultures decreased from 25.5 to 25 and increased from 12.5 to 14.3 among non-participating hospitals. The rate also dropped for long-term care nursing home facilities using the protocol, from 14.8 to 8.2, by the end of the study period.

“Decolonization only works if products are correctly applied,” the researchers noted. “Initial training was needed to ensure proper application, and ongoing training was needed due to high staff turnover and gaps in bathing practices. “Nevertheless, the SHIELD-OC intervention was implemented by usual facility staff with existing leadership support, suggesting that reported gains should be achievable if similar adherence is attained.”