Susan S. Huang, MD, MPH Chancellor's Professor, Infectious Diseases School of Medicine Department of Epidemiology and Infection Prevention University of California Irvine School of Medicine, Irvine

Regional Decolonization Efforts in Hospitals and Nursing Homes Led to Reduced Infections, Hospitalizations, Costs and Deaths Interview with:

Susan S. Huang, MD, MPHChancellor's Professor, Infectious Diseases School of Medicine Department of Epidemiology and Infection Prevention University of California Irvine School of Medicine, Irvine

Dr. Huang

Susan S. Huang, MD, MPH
Chancellor’s Professor, Infectious Diseases
School of Medicine
Department of Epidemiology and Infection Prevention
University of California Irvine School of Medicine, Irvine What is the background for this study? Would you describe the decolonization techniques?


  • This study arose from a growing concern about the increasing number and presence of antibiotic-resistant bacteria causing colonization and infection in hospitals and long-term care. CDC has had a longstanding interest in the value of regional control of these contagious pathogens and they funded this study.
    The study was actually in two parts:

    • –1) Simulate various infection prevention strategies in a model and see which works best, and then
    • – 2) Do it in real life.
      The SHIELD project was the real-life example of our simulation finding that decolonization would work the best to prevent harm from antibiotic-resistant bacteria.
  • The regional idea is that it takes all of us working together – hospitals, nursing homes, and long-term acute care hospitals – to prevent the spread and sharing of contagious pathogens. What we can accomplish together is far greater than what any of us can do alone.
  • In this study, decolonization was the use of topical chlorhexidine antiseptic soap and povidone-iodine nasal ointments to reduce potentially harmful bacteria on the body during times when patients and residents may be at risk for infection. We swapped out bathing and showering soap with CHG in participating facilities and ensured that staff knew to clean the body well, including wounds, devices, and rashes where germs can hide and cause infection. For CHG, this involved 4% rinse off product in the shower and 2% no-rinse CHG for bed baths. What are the main findings?

  • We found several things. First, we reduced MDRO (Multidrug-Resistant Organisms) colonization across the region – the amount of antibiotic-resistant bacteria on the skin and in the noses of patients in hospitals and long-term care settings – by 14-33% depending on the setting (14% in hospitals, 22% in LTACHs, 33% in nursing homes). Colonization is the greatest risk factor for later infection.
  • This led to the second finding, where we reduced MDRO infections – clinical cultures of antibiotic-resistant bacteria, by similar amounts
  • Third, this led to reduced hospitalizations from infections among nursing home residents.
  • Finally, the reduced hospitalizations led to reductions in costs and deaths. Over the course of the 25-month intervention, we estimate that we prevented 800 hospitalizations and 60 deaths in nursing home residents.  Were there any side effects, ie allergic reactions?

  • We had 5 reported events of mild skin irritation out of an estimated 50,000 patients who received the decolonization strategy. All side effects resolved quickly, including in the 3 patients who chose to continue use. What recommendations do you have for future research as a results of this study?

  • We hope that these findings encourage uptake of this topical strategy by healthcare facilities and public health agencies in other counties and regions to help stem the tide of resistant bacteria and the infections, hospitalizations, and deaths that they cause.
  • Effort is needed to ensure that the soap and ointments are correctly applied. It is common to assume that everyone knows how to bathe, but when you have patients and residents with wounds, lines, tubes, devices, and rashes, it’s important to remind everyone that those are the exact areas that need to be cleaned the most to prevent infection. Is there anything else you would like to add? Any disclosures?

  • We believe these findings should be of high interest to health insurers who can incentivize the uptake of these quality improvement initiatives to improve health and lower hospitalization costs as was shown in this study.
  • In the SHIELD study and other studies that we have conducted, participating hospitals and nursing homes received contributed antiseptic products from Xttrium, Stryker, and Medline.


Gussin GM, McKinnell JA, Singh RD, et al. Reducing Hospitalizations and Multidrug-Resistant Organisms via Regional Decolonization in Hospitals and Nursing Homes. JAMA. Published online April 01, 2024. doi:10.1001/jama.2024.2759

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Last Updated on April 1, 2024 by Marie Benz MD FAAD