Toolkit for Decolonization of Non-ICU Patients With Devices

This toolkit can help hospital infection prevention programs implement a decolonization protocol that was found to reduce bloodstream infections by more than 30 percent in adult inpatients who were not in intensive care units (ICUs) and who had specific medical devices. It includes implementation instructions, demonstration videos, and customizable tools. 

Toolkit Contents

The toolkit contains protocols for implementing decolonization with chlorhexidine gluconate antiseptic soap and mupirocin along with instructional handouts for staff and patients, written and video training materials to educate staff, staff skills assessments, “huddle” documents with key reminders, and frequently asked questions for staff and patients. It is suggested that you start with Introduction—Toolkit Overview and Recommended Prelaunch Activities, but use the other materials in any order or combination that meets your facility’s needs.

The contents of this toolkit are below:

Introduction—Toolkit Overview, Decision Making, and Recommended Prelaunch Activities
Nursing Protocols
Instructional Handouts for Staff and Patients
Staff Training Documents and Videos
Staff Training Videos
Adherence and Skills Assessment
Staff Huddle Documents
Frequently Asked Questions and Talking Points

About the Toolkit Development

This toolkit was developed by infection prevention leaders for infection prevention leaders through an AHRQ-funded project that brought together subject matter experts and providers in the field. It is based on intervention materials successfully used in the Active Bathing to Eliminate (ABATE) Infection Trial¹, funded by the National Institutes of Health. This trial was conducted in 53 community hospitals in HCA Healthcare (formerly Hospital Corporation of America). Among non-ICU patients with specific medical devices (namely central venous catheters, midline catheters, and lumbar drains), the ABATE Infection Trial found that decolonization with chlorhexidine gluconate antiseptic bathing soap plus use of nasal antibiotic ointment in the subset of device patients characterized as carriers of methicillin-resistant Staphylococcus aureus (MRSA), was associated with a 37 percent reduction in MRSA and vancomycin-resistant enterococcus positive clinical cultures, and a 32 percent reduction in all-cause bloodstream infections.

ABATE Infection Toolkit Development Project Partners:

Johns Hopkins Medicine
Division of Infectious Diseases, University of California Irvine School of Medicine

Reference

1. Huang SS, Septimus E, Kleinman K, et al. Chlorhexidine versus routine bathing to prevent multi drug-resistant organisms and all-cause bloodstream infection in general medical and surgical units: the ABATE Infection Cluster Randomized Trial. Lancet. 2019 Mar 23;393(10177):1205-15. PMID: 30850112.