TY - JOUR
T1 - Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial)
T2 - a cluster-randomised trial
AU - ABATE Infection trial team
AU - Huang, Susan S.
AU - Septimus, Edward
AU - Kleinman, Ken
AU - Moody, Julia
AU - Hickok, Jason
AU - Heim, Lauren
AU - Gombosev, Adrijana
AU - Avery, Taliser R.
AU - Haffenreffer, Katherine
AU - Shimelman, Lauren
AU - Hayden, Mary K.
AU - Weinstein, Robert A.
AU - Spencer-Smith, Caren
AU - Kaganov, Rebecca E.
AU - Murphy, Michael V.
AU - Forehand, Tyler
AU - Lankiewicz, Julie
AU - Coady, Micaela H.
AU - Portillo, Lena
AU - Sarup-Patel, Jalpa
AU - Jernigan, John A.
AU - Perlin, Jonathan B.
AU - Platt, Richard
N1 - Funding Information:
Sage Products and Mölnlycke contributed antiseptic chlorhexidine product to this trial. Investigators are also taking part in other studies in which participating health-care facilities receive antiseptic products from Sage Products (Stryker) (KK, LH, MHC, MKH, RAW, SSH), 3M (LH, SSH), Clorox (CS-S, ES, JH, JM, JS-P, KH, KK, LH, LS, MHC, MKH, RAW, RP, SSH, TRA), Xttrium (LH, SSH), and Medline (CS-S, ES, JH, JM, JS-P, KH, KK, LH, LS, MHC, MKH, RAW, RP, SSH, TRA). MKH, MHC, LS, KH, and RP received investigator-initiated grant funds from Clorox. All other authors declare no competing interests.
Funding Information:
This project was funded by the National Institutes of Health Common Fund and administered by the National Institute of Allergy and Infectious Diseases (UH2/UH3 AT007769–0 to SSH). The findings and conclusions expressed in this Article are those of the authors and do not necessarily represent the official position of the National Institutes of Health or the CDC. We thank the following individuals for their invaluable contribution: Laurie Brewer, Jane Englebright, Andrew Ko, Deborah Lilly, Bradley Ninness, Russell Poland, Lorraine Rognstad, Deepak Sharma, and David Vulcano; Dottie White from HCA; and Grace Lee from the Harvard Pilgrim Health Care Institute and Harvard Medical School. We also thank Sage Products for providing bathing demonstrations to the decolonisation group. We especially recognise and thank the unit staff and leadership, infection prevention programmes, nurse educators, microbiology laboratories, and administrative leadership at all of the participating hospitals for their commitment and dedication to this trial: Blake Medical Center (Bradenton, FL), Chippenham Johnston Willis Medical Center (Richmond, VA), Cartersville Medical Center (Cartersville, GA), Clear Lake Regional Medical Center (Webster, TX), Coliseum Northside Hospital (Macon, GA), Colleton Medical Center (Walterboro, SC), Conroe Regional Medical Center (Conroe, TX), Corpus Christi Medical Center (Corpus Christi, TX), Eastside Medical Center (Snellville, GA), Garden Park Medical Center (Gulfport, MS), Hendersonville Medical Center (Hendersonville, TN), Henrico Doctors' Hospital (Richmond, VA), John Randolph Medical Center (Hopewell, VA), Kingwood Medical Center (Kingwood, TX), Las Colinas Medical Center (Irving, TX), Las Palmas Medical Center (El Paso, TX), Lee's Summit Medical Center (Lee's Summit, MO), LewisGale Hospital Alleghany (Low Moor, VA), Medical Center of Plano (Plano, TX), Methodist Hospital (San Antonio, TX), Methodist Specialty and Transplant Hospital (San Antonio, TX), Methodist Stone Oak Hospital (San Antonio, TX), Methodist Texsan Hospital (San Antonio, TX), MountainView Hospital (Las Vegas, NV), North Hills Hospital (North Richland Hills, TX), Northside Hospital (St Petersburg, FL), North Suburban Medical Center (Thornton, CO), Northeast Methodist Hospital (Live Oak, TX), Orange Park Medical Center (Orange Park, FL), Osceola Regional Medical Center (Kissimmee, FL), Overland Park Regional Medical Center (Overland Park, KS), Palms West Hospital (Loxahatchee, FL), Parkland Medical Center (Derry, NH), Parkridge East Hospital (Chattanooga, TN), Parkridge Medical Center (Chattanooga, TN), Plaza Medical Center of Fort Worth (Fort Worth, TX), Portsmouth Regional Hospital (Portsmouth, NH), Regional Medical Center of Acadiana (Lafayette, LA), Research Medical Center (Kansas City, MO), Reston Hospital Center (Reston, VA), Rio Grande Regional Hospital (McAllen, TX), South Bay Hospital (Sun City Center, FL), St David's Medical Center (Austin, TX), St Petersburg General Hospital (St Petersburg, FL), Summit Medical Center (Hermitage, TN), Sunrise Hospital and Medical Center (Las Vegas, NV), Timpanogos Regional Hospital (Orem, UT), TriStar Horizon Medical Center (Dickson, TN), TriStar Southern Hills Medical Center (Nashville, TN), Valley Regional Medical Center (Brownsville, TX), West Florida Hospital (Pensacola, FL), West Hills Hospital & Medical Center (West Hills, CA), and West Palm Hospital (West Palm Beach, FL).
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/3/23
Y1 - 2019/3/23
N2 - Background: Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units. Methods: The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered with ClinicalTrials.gov, number NCT02063867. Findings: There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures (figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73–0·87) in the decolonisation group versus 0·87 (95% CI 0·79–0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 (<1%) adverse events, all involving chlorhexidine, among 183 013 patients in units assigned to chlorhexidine, and none were reported for mupirocin. Interpretation: Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients. Funding: National Institutes of Health.
AB - Background: Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units. Methods: The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered with ClinicalTrials.gov, number NCT02063867. Findings: There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures (figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73–0·87) in the decolonisation group versus 0·87 (95% CI 0·79–0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 (<1%) adverse events, all involving chlorhexidine, among 183 013 patients in units assigned to chlorhexidine, and none were reported for mupirocin. Interpretation: Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients. Funding: National Institutes of Health.
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U2 - 10.1016/S0140-6736(18)32593-5
DO - 10.1016/S0140-6736(18)32593-5
M3 - Article
C2 - 30850112
AN - SCOPUS:85063029034
VL - 393
SP - 1205
EP - 1215
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 10177
ER -