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Hospitals and retirement homes in California and Illinois are testing a surprisingly simple strategy against dangerous, antibiotic-resistant superbugs that kill thousands of people each year: wash patients with special soap.

Efforts – approximately $ 8 million in funding from federal disease control and prevention centers – are taking place in 50 facilities in both states.

This innovative approach recognizes that superbugs do not remain isolated in a hospital or retirement home, but evolve quickly in a community, said Dr. John Jernigan, director of the CDC's office-based infection research office. health.

"No health facility is an island," Jernigan said. "We are all in this complicated network."

In the United States, at least 2 million people are infected each year with an antibiotic-resistant bacterium, and about 23,000 people die from it, according to the CDC.

Hospitalized people are vulnerable to these insects, and people living in retirement homes are particularly vulnerable. Dr. Susan Huang, an infectious disease specialist at the University of California at Irvine, said that up to 15% of hospitalized patients and 65% of nursing home residents harbor drug-resistant organisms, although not all develop an infection.

Nurse Cristina Zainos prepares a special wash with antimicrobial soap. (Photo: Marco's Heidi, Kaiser Health News)

"The superbugs are scary and they do not falter," said Huang. "They do not leave."

Some of the most common bacteria in health facilities are methicillin-resistant Staphylococcus aureus, or MRSA, and carbapenem-resistant enterobacteria, or CRE, often referred to as "nightmarish bacteria". this category when they become resistant to last-resort antibiotics called carbapenems. CRE bacteria cause about 600 deaths a year, according to the CDC.

ERCs have "spread widely" in health care facilities in the Chicago area, said Dr. Michael Lin, an infectious disease specialist at the Rush University Medical Center, who leads the CDC-funded initiative. "If MRSA is a super-bacterium, it's the extreme – the super-super-bacterium."

Containing dangerous bacteria has been a challenge for hospitals and retirement homes. As part of the CDC's efforts, physicians and health professionals in Chicago and Southern California use chlorhexidine antimicrobial soap, which has been shown to be effective in reducing infections when patients bathe with it. Although chlorhexidine is frequently used for baths in hospital intensive care units and as a mouthwash for dental infections, it is used less for nursing homes.

In Chicago, researchers are working with 14 retirement homes and long-term care hospitals, where staff are examining people to detect CRE bacteria at admission and bathing them daily with chlorhexidine.

The Chicago project, which began in 2017 and ends in September, includes a campaign to promote handwashing and increased communication between hospitals where patients carry drug-resistant organisms.

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The work of infection control was new in many retirement homes, which do not have the same resources as hospitals, Lin said.

In fact, according to an analysis by Kaiser Health News, three-quarters of nursing homes in the United States have received citations for infection control problems over a four-year period, and facilities with repeated citations have almost never been fined. Residents of retirement homes are often referred to the hospital because of infections.

In California, health officials are closely monitoring the CRE bacteria, which are less present there than elsewhere in the country, and are trying to prevent CRE from setting up there, said Dr Matthew. Zahn, medical director of epidemiology at Orange County Health Care. Agency. "We do not have an infinite duration," he said. "It is very important to try to change the trajectory of CRE now."

The CDC-funded project in California is based in Orange County, where 36 hospitals and nursing homes use antiseptic washing with an iodine-based nasal swab. The goal is to prevent new people from contracting drug-resistant bacteria and preventing people already infected with the bacteria on their skin or elsewhere from developing infections, said Huang, who runs the project.

Huang started the project by studying patient movements in various hospitals and retirement homes in Orange County and discovered that they were doing much more than they had imagined. This sparked a key question: "What can we do to protect not only our patients, but also to protect them when they begin to move everywhere?", She recalled.

His previous research had shown that MRSA patients who used chlorhexidine to wash and rinse their mouths and dabbed their nose with a nasal antibiotic could reduce their risk of getting MRSA by up to 30%. But all patients in this study, published in February in the New England Journal of Medicine, had already left hospitals.

The goal now is to target patients still in hospitals or nursing homes and extend the work to CRE. Traditional hospitals participating in the new project are focusing on patients in intensive care units and those already carrying drug-resistant bacteria, while nursing homes and long-term care hospitals are cleaning – also called "Decolonization" – every day. resident.

A recent morning at the Coventry Court Health Center, a retirement home in Anaheim, California, Neva Shinkle, 94, sat patiently in her wheelchair. Joana Bartolome, a nurse specialized in vocational training, was wiped her nose and asked if she remembered what had happened.

"It kills germs," ​​Shinkle replied.

"That's right, it protects you from infection."

In a nearby room, Raveena Singh, UC-Irvine project coordinator, spoke with Caridad Coca, 71, who recently arrived on the site. She explained that Coke would wash herself with chlorhexidine rather than with ordinary soap. "If you have some kind of open wound or cut, it will help protect you from infection," Singh said. "And we do not just protect you, a person. We protect everyone in the retirement home. "

Coke told that she had a cousin who had spent months in the hospital after contracting MRSA. "Fortunately, I never had it," she says.

Coventry Court Administrator Shaun Dahl said he was eager to attend because people were arriving at the nursing home carrying MRSA or other insects. "They were sick there and they are sick here," said Dahl.

The results of the Chicago project are pending. The preliminary results of the Orange County project, which ends in May, show that it seems to work, Huang said. After 18 months, researchers found a 25% decrease in drug-resistant organisms among nursing home residents, 34% in long-term care hospital patients and 9% in traditional hospital patients. The most dramatic decreases were observed in CRE, although the number of patients with this type of bacteria was smaller.

Preliminary data also show a promising training effect in institutions that are not part of the effort, indicating that the project is starting to make a difference in the county, said Zahn of the United States. Orange County Health Agency.

"In our community, we have seen an increase in antimicrobial resistant infections," he said. "This offers the opportunity to intervene and curve the curve in the right direction."

Kaiser Health News is a national health policy information service that is part of the non-partisan Henry J. Kaiser Family Foundation.

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