ICU Management & Practice, Volume 19 - Issue 1, 2019
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According to results of the ABATE infection trial, daily bathing with an antiseptic soap, plus nasal ointment for patients with prior antibiotic-resistant bacteria reduced hospital-acquired infections among patients with central venous catheters and other devices.
The trial evaluated whether daily bathing with an antiseptic soap for all patients and nasal mupirocin antibiotic ointment in the nose of patients with a history of Methicillin Resistant Staphylococcus Aureus (MRSA) could potentially reduce hospital infections and antibiotic-resistant bacteria.
"Several ICU trials have shown striking reductions in infections and antibiotic-resistant bacteria using daily chlorhexidine bathing and nasal decolonisation with mupirocin. We wanted to know if patients outside the ICU could benefit from a similar decolonisation strategy," said lead author Susan S. Huang, MD, MPH, Professor of Medicine, Division of Infectious Diseases, University of California, Irvine School of Medicine.
The findings show that only patients with devices such as central venous catheters, midline catheters, and lumbar drains benefitted from this intervention, but no significant benefit was observed in other non-ICU patients. Patients with devices showed a 30% decrease in bloodstream infections and a 40% decrease in antibiotic-resistant organisms. A possible explanation for benefit in these particular patients may be because they are at a higher risk of infection. As it is, patients with devices account for more than half of all bloodstream infections in the hospital.
Senior author Richard Platt, MD, MSc, Professor, and Chair of the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School points out that many hospitals have adopted antiseptic bathing for patients with devices outside the ICU even before the availability of any scientific evidence. However, findings from this trial provide additional support for this strategy, and thus it might be worthwhile to adopt the decolonisation strategy as best practice in non-ICU patients with devices to reduce bloodstream infection and antibiotic-resistant bacteria.
References:
Huang SS, Septimus E, Kleinman K et al. (2019) Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial. The Lancet. doi.org/10.1016/S0140-6736(18)32593-5
