# Use of standardized nasal and skin decolonization to reduce rates of bacteremia in patients undergoing extracorporeal membrane oxygenation

## TL;DR

This study examined whether using chlorhexidine baths and nasal decolonization could reduce blood infections in ECMO patients, but found no significant decrease in certain bloodstream infections.

## Contribution

The study evaluates the impact of a universal decolonization protocol on ECMO-attributable bacteremia rates in a real-world clinical setting.

## Key findings

- Implementation of decolonization did not significantly reduce overall bloodstream infections.
- There was a nonsignificant decrease in MRSA bloodstream infections after decolonization.
- Enterococcus bloodstream infections increased significantly after the protocol was implemented.

## Abstract

We aimed to determine if implementation of universal nasal decolonization with daily chlorhexidine bathing will decrease blood stream infections (BSI) in patients undergoing extracorporeal membrane oxygenation (ECMO).

Retrospective cohort study.

Tertiary care facility.

Patients placed on ECMO from January 1, 2017 to December 31, 2023.

Daily bathing with 4% chlorhexidine soap and universal mupirocin nasal decolonization were initiated for all ECMO patients May 2021. The primary outcome was rate of ECMO-attributable positive blood cultures. Zero-inflated Poisson regression analysis was performed to estimate rate ratios (RRs) for the association between decolonization with BSI rates.

A total of 776 patients met inclusion criteria during the study period, 425 (55%) preimplementation and 351 (45%) post-implementation. Following implementation of decolonization, the overall incidence rate of BSI increased nonsignificantly from 10.7 to 14.0 infections per 1000 ECMO days (aRR 1.09, 95% CI 0.74–1.59). For gram-positive cocci (GPC) pathogens, a nonsignificant 40% increased rate was observed in the post-implementation period (RR 1.40, 95% CI 0.89–2.21), due mostly to a significant increase in the crude rate of Enterococcus BSI (RR 1.89, 95% CI 1.01–3.55). Excluding Enterococcus resulted in a nonsignificant 28% decreased rate (aRR 0.72, 95% CI 0.39-1.36) due to a nonsignificant 55% decreased rate of MRSA (aRR 0.45, 95% CI 0.18–3.58).

Implementation of a universal decolonization protocol did not significantly reduce rates of certain BSIs, including MRSA and other gram-positive pathogens. Although nonsignificant, reduction in BSI rates in this patient population has important implications on surveillance metrics, such as MRSA, and in the future, hospital-onset bacteremia.