Decolonization in Nursing Homes to Prevent Infection and Hospitalization

This cluster-randomized trial (Protect trial, NCT03118232) evaluated universal decolonization vs. routine bathing in 28 nursing homes (28,956 residents) over 36 months. Intervention:

Chlorhexidine bathing for all showers and baths (4% rinse-off or 2% no-rinse cloths)

Nasal povidone-iodine (iodophor) twice daily for 5 days upon admission and biweekly Primary outcome: transfer to hospital due to infection

Infection-related hospitalizations:

Routine care: 62.2% → 62.6%

Decolonization: 62.9% → 52.2%

Risk ratio: *0.83 (95% CI: 0.79–0.88); P < 0.001

Number needed to treat (NNT): 9.7 Secondary outcome: hospitalization for any reason

Routine care: 36.6% → 39.2%

Decolonization: 35.5% → 32.4%

Risk ratio: 0.92 (95% CI: 0.88–0.96)

NNT: 8.9 MDRO carriage (subset analysis):

Reduced from 48.9% to 32.0% in decolonization group

Significant declines in MRSA (↓27%), VRE (↓71%), and ESBL (↓50%)

CRE rates were unchanged Adherence: chlorhexidine ~95% at admission, iodophor ~60% at admission Mild adverse events included rash (34 cases) and one sore throat, most during early training phase

This cluster-randomized trial (Protect trial, NCT03118232) evaluated universal decolonization vs. routine bathing in 28 nursing homes (28,956 residents) over 36 months. Intervention:

Chlorhexidine bathing for all showers and baths (4% rinse-off or 2% no-rinse cloths)

Nasal povidone-iodine (iodophor) twice daily for 5 days upon admission and biweekly Primary outcome: transfer to hospital due to infection

Infection-related hospitalizations:

Routine care: 62.2% → 62.6%

Decolonization: 62.9% → 52.2%

Risk ratio: *0.83 (95% CI: 0.79–0.88); P < 0.001

Number needed to treat (NNT): 9.7 Secondary outcome: hospitalization for any reason

Routine care: 36.6% → 39.2%

Decolonization: 35.5% → 32.4%

Risk ratio: 0.92 (95% CI: 0.88–0.96)

NNT: 8.9 MDRO carriage (subset analysis):

Reduced from 48.9% to 32.0% in decolonization group

Significant declines in MRSA (↓27%), VRE (↓71%), and ESBL (↓50%)

CRE rates were unchanged Adherence: chlorhexidine ~95% at admission, iodophor ~60% at admission Mild adverse events included rash (34 cases) and one sore throat, most during early training phase