Superbug Infection Protocol Shown to Reduce Hospitalization, Deaths Among Nursing Home Residents

Infection-related hospitalizations and deaths among nursing home residents decreased as a result of a coordinated intervention adopted by facilities, along with hospitals and long-term acute care hospitals (LTCHs).

The intervention, called SHIELD-OC, was centered around reducing superbugs, or multidrug-resistant organisms (MDROs), and involved 35 health care facilities in Orange County, Calif., according to a study published Monday in JAMA Network.

“Mitigating antibiotic resistance remains a global priority,” study authors said. “Because MDROs spread across health care facilities as patients are shared among them, multifacility regional collaboration can synergistically interrupt MDRO dissemination beyond what facilities can achieve independently.”


Prior regional efforts focused on a single MDRO or facility type, the study found, while SHIELD-OC aimed to prevent multiple MDROs across acute and long-term care settings.

Infections due to MDROs are linked with increased morbidity, length of hospitalization, and health care costs, researchers said, and a “decolonization collaborative” was sought to lower MDROs and incident clinical cultures through chlorhexidine bathing and nasal decolonization.

The study’s success led to a regional nursing home incentive program supported by CalOptima, the sole Medicaid provider in Orange County. The program was offered countywide to nursing homes with 28 enrolled facilities between July 2019 and June 2022, but was eventually terminated due to budgetary constraints linked to the pandemic.


Twenty-one of the 28 facilities opted to continue using decolonization intervention despite the discontinuation of the incentive program.

For the 16 nursing homes that participated in the study, the mean MDRO prevalence decreased from 63.9% to 49.9%; results among the three LTCHs was even more staggering, dropping from 80% to 53%. MDRO mean prevalence decreased from 64.1% to 55.4% in hospitals.

“The SHIELD-OC regional decolonization intervention was associated with significant reductions in MDRO prevalence,” researchers said. “Our findings of a 23% to 30% reduction in MDRO-positive clinical cultures in NHs and LTACHs are consistent with those from randomized clinical trials of universal decolonization in hospital ICUs, non-ICUs, and post-discharge settings.”

Participating nursing homes reported 1.94 infection-related hospitalizations per 1,000 resident days, a decrease compared to 2.31 at baseline. That translates to a 27% reduction in infection-related hospitalizations among nursing home residents.

It appears that LTCHs and nursing homes saw greater success than hospitals with the decolonization protocol, and greater reductions in MDRO prevalence, because length of stay is longer.

In terms of reduced costs for infection-related hospitalizations per 1,000 resident days, nursing homes saw a decrease from $64,651 to $55,149. The rate of deaths per 1,000 resident days decreased from 0.29 at baseline to 0.25.

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