Universal Decolonization in Nursing Homes — Apparent Benefits but Feasible?

This editorial reviews the Protect trial, a cluster-randomized study evaluating universal decolonization in 28 California nursing homes. The intervention, involving nasal povidone-iodine and chlorhexidine bathing, reduced infection-related hospital transfers (risk ratio 0.83) and all-cause transfers (RR 0.92), with a number needed to treat of 9.7. Despite the benefits, feasibility concerns arise due to resource requirements, staff training, adherence variability, and uncertain long-term effects of chlorhexidine use. Dropouts, potential bias, and implementation burdens further complicate adoption. The authors argue for incentivized high-quality care and further data to support broad decolonization in resource-limited long-term care settings.

This editorial reviews the Protect trial, a cluster-randomized study evaluating universal decolonization in 28 California nursing homes. The intervention, involving nasal povidone-iodine and chlorhexidine bathing, reduced infection-related hospital transfers (risk ratio 0.83) and all-cause transfers (RR 0.92), with a number needed to treat of 9.7. Despite the benefits, feasibility concerns arise due to resource requirements, staff training, adherence variability, and uncertain long-term effects of chlorhexidine use. Dropouts, potential bias, and implementation burdens further complicate adoption. The authors argue for incentivized high-quality care and further data to support broad decolonization in resource-limited long-term care settings.