UCI Health study finds regional infection control collaboration reduced infections and deaths from antibiotic-resistant organisms

Protocol also reduced the number of difficult-to-treat superbugs in the study region

Dr. Susan Huang is one of the nation’s leading researchers dedicated
to finding strategies to reduce the risk of MDRO infection and spread
in the healthcare setting — both hospitals and nursing homes.

Orange, Calif. — A new UCI Health study has found that the collaborative use of antiseptic soap and nasal ointment among patients in hospitals and residents of nursing homes and long-term care facilities across a region can significantly lower infections, hospitalizations, costs and deaths, as well as hard-to-treat antimicrobial-resistant bacteria, also known as superbugs.

The study, “Reducing Hospitalizations and Multidrug-Resistant Organisms (MDROs) via Regional Decolonization in Hospitals and Nursing Homes,” published in the April 1, 2024 online edition of the Journal of the American Medical Association found that the cleansing method reduced Countywide MDRO infections by up to 30%, and lowered hospitalizations due to infection among nursing home residents by 27%. The drop in hospitalizations also lowered associated deaths by 24%.

The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County (SHIELD-OC) was a regional collaboration across 35 Southern California healthcare facilities, including 16 hospitals, 16 nursing homes and three long-term acute care hospitals. Facilities that participated in SHIELD-OC adopted a patient cleansing protocol (called decolonization) using an antiseptic soap (chlorhexidine) for routine bathing and showering and nasal ointment (iodophor) in patients

“This study provides further evidence that the fight against the spread of antimicrobial resistance starts at the regional level and is most likely to be successful if approached across healthcare facilities. Preventing the spread of resistant germs in one healthcare facility can protect patients and residents at that facility, but also at facilities receiving patients via transfer, resulting in synergy across the regional healthcare network,” said Kara Jacobs-Slifka, MD, lead for long-term care at Centers for Disease Control and Prevention.

Chlorhexidine and iodophor are over-the-counter products that have been safely used in healthcare for over 60 years, and they work to kill germs on the surface of the skin and in the nose. In this way, they help prevent infections that are commonly caused by our body’s own bacteria during high-risk moments due to surgery, medical devices, wounds, skin problems, or an inability to perform usual hygiene activities. The SHIELD-OC study included over 50,000 patients in hospitals and long-term care facilities and was conducted from July 2017 through July 2019.

The study was funded by the Centers for Disease Control and Prevention, which reports that more than 2.8 million antimicrobial-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result. These include infections due to methicillin-resistant Staphylococcus aureus (MRSA) and other antibiotic-resistant pathogens which can live on a person’s skin and in their nose and increase the chances of developing a later infection or spreading it to others.

“Antimicrobial resistance is one of the largest growing global public health threats, and the emergence of MDROs continues to outpace the development of new antibiotics to treat these infections. Given this situation, prevention becomes essential,” said Dr. Susan Huang, MD, MPH, medical director of epidemiology and infection prevention for UCI Health, the clinical enterprise of UCI, Chancellor's Professor in the Division of Infectious Diseases at UCI School of Medicine, and principal investigator of the study.

“The use of over-the-counter chlorhexidine antiseptic soap and nose ointment provides a relatively simple, cost-effective, and proven strategy to reduce the spread of MDROs and the infections they cause. By working together, healthcare leaders can stop the spread within and between hospitals and nursing homes to prevent infections and save lives.”

SHIELD-OC was a program led by UCI Health that demonstrated that a coordinated regional infection prevention strategy reduces hospitalizations, deaths, and healthcare costs. Since the funding for the program ended, multiple hospitals and a growing number of nursing homes (20+) have continued or newly-adopted the decolonization intervention on their own.

For hospitals and long-term care facilities interested in learning more about SHIELD-OC, all protocols and training materials are available at www.ucihealth.org/shield

Learn more about the study 

Listen to the authors discuss their research on the American Medical Association Ed Hub Podcast.

About UCI Health

UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center, a 459-bed, acute care hospital in in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America’s Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center, high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center, gold level 1 geriatric emergency department and regional burn center. UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County. Follow us on Facebook, Instagram, LinkedIn and Twitter