9-month pilot study showed a 55% reduction in resident colonization with MRSA, VRE, and ESBL, but contamination of high-touch surfaces persisted in rooms of MDRO carriers.
Nursing home infectious diseases risk
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A 9-month pilot study in three nursing homes found that routine chlorhexidine bathing and nasal iodophor use reduced multidrug-resistant organism (MDRO) colonization among residents by 55%, but did not significantly affect environmental contamination in rooms of MDRO carriers.1
Researchers analyzed outcomes across a baseline, phase-in, and intervention period. Colonization rates decreased from 46% (411/900) at baseline to 29% (262/900) during the intervention (odds ratio (OR), .45; P < .001). Significant reductions were observed in colonization with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and extended-spectrum beta-lactamase producers (ESBL) (P < .001 for all).1
Despite these reductions, environmental contamination remained high in rooms of residents who continued to carry MDROs. Of 330 colonized residents, 288 rooms (87%) had at least one high-touch object contaminated with an MDRO. Multivariable analysis found that contamination was associated with antibiotic use (OR, 1.54; 95% CI, 1.19–1.98), presence of wounds (OR, 1.34; 95% CI, 1.02–1.77), and certain fomites such as bedside tables and bedrails (OR, 12.7; 95% CI, 9.37–17.25). The intervention period itself was not significantly associated with changes in contamination (OR, 1.02; 95% CI, .81–1.27).1
Routine chlorhexidine bathing and nasal iodophor reduced resident MDRO colonization from 46% to 29% (OR, 0.45; P < .001).
Environmental contamination remained high, with 87% of rooms of colonized residents showing MDRO-positive surfaces.
Antibiotic use, wounds, and high-touch fomites such as bedrails were strongly linked to contamination, underscoring the need for targeted cleaning strategies.
The investigators concluded that while decolonization strategies effectively reduce resident-level MDRO burden, additional measures targeting environmental cleaning in rooms of MDRO carriers are necessary to curb transmission risk.1
Findings from another setting echo these challenges. A study reported by Contagion on August 4, 2025, evaluated Candida auris exposure in dialysis centers across four US states. Standard infection prevention and control (IPC) practices, including bleach disinfection, routine use of PPE, and short patient stays, were sufficient to prevent new transmissions, even when facilities were unaware of colonization status. Although, communication gaps between healthcare settings delayed containment.2
Together, these studies highlight the complexity of MDRO control in congregate care. Nursing homes demonstrated that colonization can be reduced, though environmental reservoirs persist. Dialysis centers showed that robust baseline IPC can block transmission despite colonization, but information sharing between facilities remains a critical weakness. Effective MDRO containment will require both strong routine IPC and improved cross-setting communication.
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