1000. Daily Chlorhexidine Bathing in General Hospital Units – Results of the ABATE Infection Trial (Active BAThing to Eliminate Infection)
Session: Oral Abstract Session: Where Did That Come From? Transmission Risks in Healthcare
Friday, October 6, 2017: 11:45 AM
Room: 01AB

Background:

Universal decolonization with daily chlorhexidine (CHG) bathing with and without nasal decolonization has significantly reduced positive MRSA clinical cultures and bloodstream infections in adult ICUs in several clinical trials. We evaluated whether decolonization was similarly effective in a lower risk hospitalized population.

 

Methods:

We conducted a 2 arm cluster-randomized trial involving a 1-year baseline period (Apr 2013-Mar 2014) and a 21-month intervention period (Jun 2014 - Feb 2016). All non-critical care units in a hospital were assigned to the same strategy. These were 1) Routine Care: routine bathing product and frequency, and 2) Decolonization: CHG for routine daily bathing (2% leave-on CHG) or showering (4% rinse-off CHG) for all patients plus mupirocin for 5 days for known MRSA. Universal ICU decolonization was in place in both arms by Sept 2013. Differences between the arms in the outcome rates between the baseline and intervention periods were assessed with proportional hazards models, using shared frailties to account for clustering by hospital. The primary analysis was as-randomized and unadjusted. Primary outcome was any MRSA or VRE clinical isolate attributable to the unit. Secondary outcome was all-cause bloodstream infections. Additional analyses adjusted for age, gender, race, Medicaid insurer, surgery, and comorbidities.

 

Results: We randomized 53 hospitals in 15 states. There were 194 adult units with 189,616 admissions in the baseline period and 340,350 in the intervention period. Common unit types included mixed medical surgical (30%), cardiac (20%), step-down (11%), medical (10%), surgical (10%), and oncology (4%). There were no significant differences between arms in the relative hazards for intervention vs. baseline for either outcome (Table and Figure). Adjusted analyses yielded similar results.

 

 

 

 

 

 

 

Conclusion: Universal daily CHG bathing or showering plus targeted mupirocin for MRSA+ patients in non-critical care units did not reduce the combination of positive MRSA and VRE clinical cultures or bloodstream infections due to all pathogens. Further analyses to assess for any differential effects in high risk subpopulations will be important.

Susan S. Huang, MD, MPH, FIDSA, FSHEA1, Edward Septimus, MD, FIDSA, FSHEA2, Ken Kleinman, ScD3, Julia Moody, MS4, Jason Hickok, RN, MBA4, Lauren Heim, MPH1, Adrijana Gombosev, MS1, Taliser Avery, MS5, Katherine Haffenreffer, BS5, Lauren Shimelman, BA5, Mary K. Hayden, MD6, Robert A. Weinstein, MD7, Caren Spencer-Smith, MT(ASCP), MIS4, Rebecca E. Kaganov, BA5, Michael V. Murphy, BA5, Tyler Forehand, BS4, Julie Lankiewicz, MPH5, Micaela H. Coady, MS5, Lena M Portillo, BS, MT(ASCP)6, Jalpa Patel Sarup, BS, MT (ASCP)6, John A. Jernigan, MD, MS8, Jonathan Perlin, MD, PhD, MSHA, FACP, FACMI4, Richard Platt, MD, MS, FIDSA, FSHEA5 and NIH Health Care Systems Research Collaboratory, (1)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, (2)Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, (3)University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, (4)Clinical Services Group, HCA Inc., Nashville, TN, (5)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, (6)Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, (7)Cook County Health and Hospitals System, Chicago, IL, (8)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA

Disclosures:

S. S. Huang, Sage Products: Receipt of contributed product , Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
Xttrium Laboratories: Receipt of contributed product , Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
Clorox: Receipt of contributed product , Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
3M: Receipt of contributed product , Conducting studies in which participating healthcare facilities are receiving contributed product (no contribution in submitted abstract), Participating healthcare facilities in my studies received contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

E. Septimus, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

K. Kleinman, Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

J. Moody, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

J. Hickok, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

L. Heim, Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

A. Gombosev, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
3M: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

T. Avery, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product; received research funds from Clorox, but Clorox has no role in the design

K. Haffenreffer, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product; receive research funds from Clorox, but Clorox has no role in the design

L. Shimelman, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product; receive research funds from Clorox, but Clorox has no role in the design

M. K. Hayden, OpGen, Inc.: Receipt of donated laboratory services for project , Research support
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

R. A. Weinstein, Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
OpGen Inc.: Receipt of donated laboratory services for project , Research support

C. Spencer-Smith, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

R. E. Kaganov, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

M. V. Murphy, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

T. Forehand, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

J. Lankiewicz, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

M. H. Coady, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product; received research funds from Clorox, but Clorox has no role in the design.
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

L. M. Portillo, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

J. Patel Sarup, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

J. A. Jernigan, None

J. Perlin, Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Clorox: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

R. Platt, Clorox: Receipt of contributed product , Conducting clinical studies in which participating healthcare facilities are receiving contributed product; receive research funds from Clorox, but Clorox has no role in the design
Molnlycke: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Sage Products: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product
Xttrium: Receipt of contributed product , Conducting studies in healthcare facilities that are receiving contributed product

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