UH3 Project: Active Bathing to Eliminate (ABATE) Infection

UH3 Project: Active Bathing to Eliminate (ABATE) Infection

Principal Investigator:

Sponsoring Institution: University of California, Irvine

Collaborators:

  • Hospital Corporation of America

  • Harvard Medical School/Harvard Pilgrim Health Care

  • University of California, Irvine, School of Medicine

  • Rush University

  • John H. Stroger Hospital

  • Centers for Disease Control and Prevention

NIH Institute Providing Oversight: National Institute of Allergy and Infectious Diseases (NIAID)

Program Official: Clayton Huntley, PhD (NIAID)

Project Scientist: Gregory Deye, MD (NIAID)

ClinicalTrials.gov Identifier: NCT02063867

Study Locations: 53 locations across the United States

Trial Status: Completed

Study Snapshot

Trial Summary

Study question and significance: Universal antiseptic bathing and nasal decolonization are known to reduce bloodstream infections and multidrug-resistant organisms in intensive care unit (ICU) settings. However, the effects of this type of decolonization outside the ICU are unknown. The objective of ABATE Infection was to evaluate the use of universal chlorhexidine bathing plus targeted nasal decolonization for methicillin-resistant Staphylococcus aureus (MRSA) carriers in hospitalized patients outside the ICU.

Design and setting: Cluster randomized trial in 53 hospitals with 194 non–critical care units, of which 26 hospitals (with 90 non–critical care units) were randomly assigned to routine care and 27 hospitals (with 104 non–critical care units) were randomly assigned to the intervention.

Intervention and methods: The intervention included daily chlorhexidine bathing for all patients in the unit plus nasal mupirocin for known MRSA carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus (VRE) clinical cultures attributed to participating units. The primary analysis was an unadjusted intention-to-treat analysis using proportional hazards models that accounted for clustering within hospitals. The analysis assessed whether the hazard ratio between the intervention and baseline periods differed significantly between study groups. Clinical cultures of multidrug-resistant, gram-negative bacteria and all-cause bloodstream infection were also evaluated as secondary outcomes.

Findings: Universal decolonization did not reduce multidrug-resistant bacteria or bloodstream infection in the overall non-ICU population. In a post hoc analysis of patients with medical devices, decolonization was associated with a significant 32% reduction in all-cause bloodstream infections and a significant 37% reduction in MRSA or vancomycin-resistant enterococcus clinical cultures attributable to participating units. Targeting patients with devices may be particularly valuable because they represented 10% of the non-ICU population but were responsible for 37% of all MRSA and VRE clinical cultures and 56% of all bloodstream infections in non-ICU patients.

Conclusions and relevance: Universal decolonization and targeted nasal decolonization did not significantly reduce the risk of multidrug-resistant infections in the overall non–critically ill patient population, but large reductions were seen in the subset of patients with medical devices.

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