Decolonization
Decolonization is an infection prevention practice that removes germs from the skin. It is often used in healthcare facilities when patients carry methicillin-resistant Staphylococcus aureus (MRSA) or other dangerous germs on their bodies. It can keep them from developing an infection themselves or passing the germs on to others.
Decolonization includes an antiseptic bathing routine using a special soap on the skin and applying an antiseptic or antibiotic product in the nose. This practice has been shown to reduce the amount of germs on the body and reduce infections overall, including hard-to-treat MRSA infections.
Implementation Resources
MRSA Prevention Toolkit: Targeting Surgical Site Infections—New
This toolkit was developed during the ÂÜÀòÊÓƵSafety Program for MRSA Prevention’s surgical services cohort, which aimed to reduce MRSA and surgical site infections in surgeries where MRSA infection is relatively more common and harmful, specifically cardiac, knee and hip replacement, and spinal fusion surgeries.
This toolkit provides the following information on decolonization:
- Evidence for MRSA decolonization.
- Nasal decolonization.
- Use of preoperative chlorhexidine skin antisepsis.
- Decolonization resources.
MRSA Prevention Toolkit: ICUs & Non-ICUs—Section on Decolonization
This toolkit was developed during the ÂÜÀòÊÓƵSafety Program for MRSA Prevention’s intensive care unit (ICU) and non-ICU cohort, which successfully reduced both MRSA and all-cause hospital-onset bacteremia in almost 200 ICUs and non-ICUs. Interventions included decolonizing patients, decontaminating the environment, preventing person-to-person spread, and preventing device- and procedure-related infections. This toolkit’s decolonization materials are adapted from the REDUCE MRSA Enhanced Protocol and Toolkit for Decolonization of Non-ICU Patients With Devices for the ÂÜÀòÊÓƵSafety Program for MRSA Prevention.
Toolkit for Decolonization of Non-ICU Patients With Devices
This toolkit was developed based on a cluster-randomized trial conducted in 53 hospitals that investigated the use of decolonization to prevent infection in non–intensive care unit patients. Patients with specific medical devices who were decolonized had a 30 percent reduction in bloodstream infections. was funded by the National Institutes of Health, and ÂÜÀòÊÓƵdeveloped a toolkit to support implementation.
Universal ICU Decolonization: An Enhanced Protocol
This protocol was developed based on the REDUCE MRSA trial, which tested universal decolonization of intensive care unit (ICU) patients compared with two other routine infection prevention practices. Universal decolonization was found to reduce all-cause bloodstream infections by more than 40 percent in ICU patients.
Evidence Base for Decolonization
Nursing Homes
PROTECT Trial
In a cluster-randomized trial of 28 nursing homes, the 14 that used universal decolonization reduced resident transfers to a hospital for infection and prevalence of multidrug-resistant organism carriage in residents.
The Shared Healthcare Intervention to Eliminate Life-Threatening Dissemination of MDROs in Orange County
In this regional quality improvement collaborative involving universal decolonization in long-term care facilities and targeted decolonization among hospital patients in contact precautions, chlorhexidine bathing and nasal decolonization were associated with significantly lower multidrug-resistant organism (MDRO) prevalence and MDRO-positive clinical cultures. Infection-related hospitalizations, associated costs, and deaths among nursing home residents also decreased.
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Acute Care Hospitals
ABATE Trial (Active Bathing to Eliminate Infection)
This cluster-randomized trial of 53 hospitals investigated the use of decolonization to prevent infection in non–intensive care unit patients. Patients with specific medical devices (central venous catheters, midline catheters, and lumbar drains) who received decolonization had a 30 percent reduction in bloodstream infections.
REDUCE MRSA Trial
In a cluster-randomized trial comparing universal decolonization to two routine infection prevention practices, universal decolonization was found to reduce all-cause bloodstream infections by more than 40 percent in intensive care unit patients.
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Post-Discharge From Acute Care Hospitals
Project CLEAR (Changing Lives by Eradicating Antibiotic Resistance)
In a randomized trial of education versus education plus decolonization in more than 2,000 known MRSA carriers, post-discharge decolonization with chlorhexidine and mupirocin led to a 30 percent reduction in MRSA infection.
