Decolonization to Prevent Healthcare-Associated Infections 2024 State-of-the-Art Review

Abstract

Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridioides difficile is associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections. This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, povidone-iodine, alcohol-based nasal antiseptic, and photodynamic therapy.

Topical decolonization agents reviewed included chlorhexidine gluconate, and povidone-iodine. Of these, CHG is the skin decolonization agent that has the strongest evidence base. There is also evidence to support the use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance. Small studies have shown some effect of fecal microbiota transplant against multidrug resistant gram-negative organisms. Some of the strongest evidence for decolonization is to prevent surgical site infections in high-risk procedures primarily cardiac and orthopedic procedures.