Huang SS, et al. - In this ABATE Infection trial, investigators examined the utility of chlorhexidine bathing in non-critical-care units similar to the intervention which helped in decreasing multidrug-resistant organisms and bacteremia in intensive care units. They observed an insignificant decline in multidrug-resistant organisms in non-critical-care patients with the use of decolonization with universal chlorhexidine bathing and targeted mupirocin for methicillin-resistant Staphylococcus aureus (MRSA) carriers.

Methods

• In this cluster-randomised trial [the ABATE Infection (active bathing to eliminate infection) trial] of 53 hospitals, they compared routine bathing to decolonization with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units.
• They performed the trial in hospitals affiliated with HCA Healthcare, consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period between April 1, 2014, and May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016.
• They categorized the participating non-critical-care units randomally to either routine care or daily chlorhexidine bathing for all subjects including mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers.
• The primary outcome ie, MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units was calculated in the unadjusted, intention-to-treat population as the HR for the intervention period vs the baseline period in the decolonization group vs the HR in the routine care group.
• Differences in outcome reductions across groups, accounting for clustering within hospitals were estimated via proportional hazards models.

Results

• A total of 189,081 candidates in the baseline period whereas 339,902 subjects including 156,889 cases in the routine care group and 183,013 patients in the decolonisation group, were observed in the intervention period across 194 non-critical-care units in 53 hospitals.
• The HR for the intervention period vs the baseline period was 0·79 (0·73–0·87) in the decolonisation group vs 0·87 (95% CI 0·79–0·95) in the routine care group for the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures.
• They recorded no variations in the relative HRs (p=0·17).
• They found 25 (<1%) adverse events with chlorhexidine group but none were noted for mupirocin.