<html xmlns:v="urn:schemas-microsoft-com:vml" xmlns:o="urn:schemas-microsoft-com:office:office" xmlns:w="urn:schemas-microsoft-com:office:word" xmlns:m="http://schemas.microsoft.com/office/2004/12/omml" xmlns="http://www.w3.org/TR/REC-html40"><head><meta http-equiv=Content-Type content="text/html; charset=utf-8"><meta name=Generator content="Microsoft Word 14 (filtered medium)"><!--[if !mso]><style>v\:* {behavior:url(#default#VML);}
o\:* {behavior:url(#default#VML);}
w\:* {behavior:url(#default#VML);}
.shape {behavior:url(#default#VML);}
</style><![endif]--><style><!--
/* Font Definitions */
@font-face
{font-family:Helvetica;
panose-1:2 11 6 4 2 2 2 2 2 4;}
@font-face
{font-family:Helvetica;
panose-1:2 11 6 4 2 2 2 2 2 4;}
@font-face
{font-family:Calibri;
panose-1:2 15 5 2 2 2 4 3 2 4;}
@font-face
{font-family:Tahoma;
panose-1:2 11 6 4 3 5 4 4 2 4;}
@font-face
{font-family:Georgia;
panose-1:2 4 5 2 5 4 5 2 3 3;}
@font-face
{font-family:Pristina;
panose-1:3 6 4 2 4 4 6 8 2 4;}
@font-face
{font-family:"Brush Script MT";
panose-1:3 6 8 2 4 4 6 7 3 4;}
@font-face
{font-family:"Gotham SSm";}
/* Style Definitions */
p.MsoNormal, li.MsoNormal, div.MsoNormal
{margin:0in;
margin-bottom:.0001pt;
font-size:11.0pt;
font-family:"Calibri","sans-serif";}
a:link, span.MsoHyperlink
{mso-style-priority:99;
color:#0563C1;
text-decoration:underline;}
a:visited, span.MsoHyperlinkFollowed
{mso-style-priority:99;
color:#954F72;
text-decoration:underline;}
span.EmailStyle17
{mso-style-type:personal;
font-family:"Times New Roman","serif";
color:#0000CC;}
span.EmailStyle18
{mso-style-type:personal-reply;
font-family:"Calibri","sans-serif";
color:#1F497D;}
.MsoChpDefault
{mso-style-type:export-only;
font-size:10.0pt;}
@page WordSection1
{size:8.5in 11.0in;
margin:1.0in 1.0in 1.0in 1.0in;}
div.WordSection1
{page:WordSection1;}
--></style><!--[if gte mso 9]><xml>
<o:shapedefaults v:ext="edit" spidmax="1026" />
</xml><![endif]--><!--[if gte mso 9]><xml>
<o:shapelayout v:ext="edit">
<o:idmap v:ext="edit" data="1" />
</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='color:#1F497D'>Deborah,<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Thank you for sending this article. It is of particular interest to me as my Mother is in an assisted living facility. <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>I have questions about the use of chlorhexidine. First, a question that is often asked, why can’t the bacteria become resistant to the disinfectant, in this case chlorhexidine? Secondly, what about the patient’s normal flora when they are bathed in a disinfectant solution? Wouldn’t that make the problem worse? <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Lastly, of course, from an environmental/waste water perspective, large amounts of chlorhexidine to the WWTP? What are the impacts there? <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>I would contact the MD on this study directly, but don’t know if I’d get a response. Any IP or Epi folks on this list? <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Very truly yours,<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Brush Script MT";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Catherine Zimmer, MS, BSMT<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Executive director, <u><a href="http://www.hearrtmidwest.wildapricot.org/"><span style='color:blue'>HEARRT Midwest</span></a></u><o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>Principal, <u>Zimmer Environmental Improvement<o:p></o:p></u></span></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:Pristina;color:#1F497D'>Improving processes, minimizing and managing waste and, reducing costs. <o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'>T: 651.645.7509<o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><a href="mailto:zenllc@usfamily.net"><span style='color:blue'>zenllc@usfamily.net</span></a><o:p></o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Pharmwaste [mailto:pharmwaste-bounces@lists.dep.state.fl.us] <b>On Behalf Of </b>Deborah DeBiasi<br><b>Sent:</b> Tuesday, April 2, 2019 9:02 AM<br><b>To:</b> pharmwaste@lists.dep.state.fl.us<br><b>Subject:</b> [Pharmwaste] Hospitals Look To Nursing Homes To Help Stop Drug-Resistant Infections<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif";color:#0000CC'><a href="https://www.npr.org/sections/health-shots/2019/04/02/707842736/enter-title">https://www.npr.org/sections/health-shots/2019/04/02/707842736/enter-title</a></span><o:p></o:p></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif";color:#0000CC'> </span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><img border=0 width=32 height=32 id="_x0000_i1025" src="cid:image001.png@01D4E937.374E79F0" alt="NPR logo"><span lang=EN style='font-size:10.5pt;font-family:"Helvetica","sans-serif"'><a href="https://www.npr.org/sections/health-shots/2019/04/02/707842736/enter-title"><b><span style='color:#6D8AC4;text-decoration:none'>Hospitals Look To Nursing Homes To Help Stop Drug-Resistant Infections</span></b><span style='color:#6D8AC4;text-decoration:none'> </span></a></span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><b><span lang=EN style='font-size:13.5pt;font-family:"Helvetica","sans-serif"'><a href="https://www.npr.org/sections/health-shots/133188449/public-health"><span style='color:#6D8AC4;text-decoration:none'>Public Health</span></a></span></b><o:p></o:p></p><p class=MsoNormal style='margin-bottom:11.25pt;background:#F9F9F9'><span lang=EN style='font-size:20.5pt;font-family:"Gotham SSm";color:#333333'>Hospitals Look To Nursing Homes To Help Stop Drug-Resistant Infections</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:9.0pt;font-family:"Gotham SSm";color:#767676'>April 2, 20195:00 AM ET </span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Helvetica","sans-serif"'>Anna Gorman </span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><b><span lang=EN style='font-size:7.5pt;font-family:"Helvetica","sans-serif";color:#636363'>From </span></b><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span style='font-size:10.5pt;font-family:"Georgia","serif"'><img border=0 width=800 height=496 id="Picture_x0020_4" src="cid:image002.jpg@01D4E937.374E79F0" alt="https://media.npr.org/assets/img/2019/03/29/superbugs-8_custom-b42a778d133352d5e62c783d043cc4fabc7ace29-s800-c85.jpg"></span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'> </span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>A certified nursing assistant wipes Neva Shinkle's face with chlorhexidine, an antimicrobial wash. Shinkle is a patient at Coventry Court Health Center, a nursing home in Anaheim, Calif., that is part of a multi-center research project aimed at stopping the spread of MRSA and CRE — two types of bacteria resistant to most antibiotics.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Heidi de Marco/KHN </span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Hospitals and nursing homes in California and Illinois are testing a surprisingly simple strategy to stop the dangerous, antibiotic-resistant superbugs that kill thousands of people each year: washing patients with a special soap.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>The efforts — funded with roughly $8 million from the federal government's Centers for Disease Control and Prevention — are taking place at 50 facilities in those two states.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>This novel collaboration recognizes that superbugs don't remain isolated in one hospital or nursing home but move quickly through a community, said <a href="https://blogs.cdc.gov/safehealthcare/authors/john-a-jernigan-md-ms/"><span style='color:#6D8AC4;text-decoration:none'>Dr. John Jernigan</span></a>, who directs the CDC's office on health care-acquired infection research.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>"No health care facility is an island," Jernigan says. "We all are in this complicated network."</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><a href="https://www.npr.org/sections/health-shots/2016/12/22/506489368/medicare-penalizes-hospitals-in-crackdown-on-antibiotic-resistant-infections"><span style='font-size:10.5pt;font-family:"Georgia","serif";color:#6D8AC4;text-decoration:none'><img border=0 width=300 height=299 id="Picture_x0020_6" src="cid:image003.jpg@01D4E937.374E79F0" alt="Medicare Penalizes Hospitals In Crackdown On Antibiotic-Resistant Infections"></span></a><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><b><span lang=EN style='font-size:13.5pt;font-family:"Georgia","serif"'><a href="https://www.npr.org/sections/health-shots/"><span style='color:#6D8AC4;text-decoration:none'>Shots - Health News </span></a></span></b><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><b><span lang=EN style='font-size:13.5pt;font-family:"Georgia","serif"'><a href="https://www.npr.org/sections/health-shots/2016/12/22/506489368/medicare-penalizes-hospitals-in-crackdown-on-antibiotic-resistant-infections"><span style='color:#6D8AC4;text-decoration:none'>Medicare Penalizes Hospitals In Crackdown On Antibiotic-Resistant Infections</span></a></span></b><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>At least 2 million people in the U.S. become infected with some type of antibiotic-resistant bacteria each year, and about 23,000 die from those infections, according to the CDC.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>People in hospitals are vulnerable to these bugs, and people in nursing homes are particularly vulnerable. Up to <a href="https://www.ncbi.nlm.nih.gov/pubmed/30753383"><span style='color:#6D8AC4;text-decoration:none'>15 percent of hospital patients and 65 percent of nursing home residents</span></a> harbor drug-resistant organisms, though not all of them will develop an infection, says <a href="https://www.faculty.uci.edu/profile.cfm?faculty_id=5478"><span style='color:#6D8AC4;text-decoration:none'>Dr. Susan Huang</span></a>, who specializes in infectious diseases at University of California, Irvine.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>"Superbugs are scary and they are unabated," Huang says. "They don't go away."</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Some of the most common bacteria in health care facilities are methicillin-resistant Staphylococcus aureus, or MRSA, and carbapenem-resistant Enterobacteriaceae, or <a href="https://www.cdc.gov/hai/organisms/cre/"><span style='color:#6D8AC4;text-decoration:none'>CRE</span></a>, often called "nightmare bacteria." <i>E.Coli</i><b> </b>and <i>Klebsiella</i> <i>pneumoniae </i>are two common germs that can fall into this category when they become<b><i> </i></b>resistant to last-resort antibiotics known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195018/"><span style='color:#6D8AC4;text-decoration:none'>carbapenems</span></a>.<b> </b>CRE bacteria<b> </b>cause an estimated 600 deaths each year, according to the CDC.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><a href="https://www.npr.org/sections/goatsandsoda/2017/01/17/510227493/a-superbug-that-resisted-26-antibiotics"><span style='font-size:10.5pt;font-family:"Georgia","serif";color:#6D8AC4;text-decoration:none'><img border=0 width=300 height=300 id="Picture_x0020_7" src="cid:image004.jpg@01D4E937.374E79F0" alt="A Superbug That Resisted 26 Antibiotics"></span></a><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><b><span lang=EN style='font-size:13.5pt;font-family:"Georgia","serif"'><a href="https://www.npr.org/sections/goatsandsoda/2017/01/17/510227493/a-superbug-that-resisted-26-antibiotics"><span style='color:#6D8AC4;text-decoration:none'>A Superbug That Resisted 26 Antibiotics</span></a></span></b><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>CRE have "basically spread widely" among health care facilities in the Chicago region, says <a href="https://www.rushu.rush.edu/faculty/michael-lin-md-mph"><span style='color:#6D8AC4;text-decoration:none'>Dr. Michael Lin</span></a>, an infectious-diseases specialist at Rush University Medical Center, who is heading the CDC-funded effort there. "If MRSA is a superbug, this is the extreme — the super superbug."</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Containing the dangerous bacteria has been a challenge for hospitals and nursing homes. As part of the CDC effort, doctors and health care workers in Chicago and Southern California are using the antimicrobial soap chlorhexidine, which <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1207290"><span style='color:#6D8AC4;text-decoration:none'>has been shown</span></a> to reduce infections when patients bathe with it.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span style='font-size:10.5pt;font-family:"Georgia","serif"'><img border=0 width=391 height=262 id="Picture_x0020_8" src="cid:image005.jpg@01D4E937.374E79F0" alt="https://media.npr.org/assets/img/2019/03/29/superbugs-9_custom-54a78ef189e3a4ddcd0cf9944b643167d63b95d9-s800-c85.jpg"></span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>The Centers for Disease Control and Prevention funds the project in California, based in Orange County, in which 36 hospitals and nursing homes are using an antiseptic wash, along with an iodine-based nose swab, on patients to stop the spread of deadly superbugs.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Heidi de Marco/KHN </span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Though hospital intensive care units frequently rely on chlorhexidine in preventing infections, it is used less commonly for bathing in nursing homes. Chlorhexidine also is sold over the counter; the FDA noted in 2017 it has caused <a href="https://www.fda.gov/downloads/Drugs/DrugSafety/UCM539059.pdf"><span style='color:#6D8AC4;text-decoration:none'>rare but severe allergic reactions</span></a>.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>In Chicago, researchers are working with 14 nursing homes and long-term acute care hospitals, where staff are screening people for the CRE bacteria at admission and bathing them daily with chlorhexidine.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>The Chicago project, which started in 2017 and ends in September, includes a campaign to promote hand-washing and increased communication among hospitals about which patients carry the drug-resistant organisms.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>The infection-control protocol was new to many nursing homes, which don't have the same resources as hospitals, Lin says.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>In fact, three-quarters of nursing homes in the U.S. received citations for infection-control problems over a four-year period, according to a <a href="https://khn.org/news/infection-lapses-rampant-in-nursing-homes-but-punishment-is-rare/"><span style='color:#6D8AC4;text-decoration:none'>Kaiser Health News analysis</span></a>, and the facilities with repeat citations almost never were fined. Nursing home residents often are sent back to hospitals because of infections.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>In California, health officials are closely watching the CRE bacteria, which are less prevalent there than elsewhere in the country, and they are trying to prevent CRE from taking hold, says <a href="http://nationalacademies.org/hmd/Activities/PublicHealth/microbialthreats/Profiles/Zahn.aspx"><span style='color:#6D8AC4;text-decoration:none'>Dr. Matthew Zahn</span></a>, medical director of epidemiology at the Orange County Health Care Agency</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>"We don't have an infinite amount of time," Zahn says. "Taking a chance to try to make a difference in CRE's trajectory now is really important."</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>The CDC-funded project in California is based in Orange County, where 36 hospitals and nursing homes are using the antiseptic wash along with an iodine-based nose swab. The goal is to prevent new people from getting drug-resistant bacteria and keep the ones who already have the bacteria on their skin or elsewhere from developing infections, says Huang, who is leading the project.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span style='font-size:10.5pt;font-family:"Georgia","serif"'><img border=0 width=800 height=480 id="Picture_x0020_10" src="cid:image006.jpg@01D4E937.374E79F0" alt="https://media.npr.org/assets/img/2019/03/29/superbugs-3_custom-3c516d9877e4b793761c0291f932fdbf9f1c2ab9-s800-c85.jpg"></span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Enlarge this image</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'> </span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Licensed vocational nurse Joana Bartolome swabs Shinkle's nose with an antibacterial, iodine-based solution at Anaheim's Coventry Court Health Center. Studies find patients can harbor drug-resistant strains in the nose that haven't yet made them sick.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Heidi de Marco/KHN </span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Huang kicked off the project by studying how patients move among different hospitals and nursing homes in Orange County — she discovered they do so far more than previously thought. That prompted a key question, she says: "What can we do to not just protect our patients but to protect them when they start to move all over the place?"</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><a href="https://www.npr.org/sections/health-shots/2017/03/18/519217051/my-unlovely-lady-lump-when-mrsa-is-ugly-but-not-life-threatening"><span style='font-size:10.5pt;font-family:"Georgia","serif";color:#6D8AC4;text-decoration:none'><img border=0 width=300 height=299 id="Picture_x0020_12" src="cid:image007.jpg@01D4E937.374E79F0" alt="My Unlovely Lady Lump: When MRSA Is Ugly, But Not Life-Threatening"></span></a><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><b><span lang=EN style='font-size:13.5pt;font-family:"Georgia","serif"'><a href="https://www.npr.org/sections/health-shots/"><span style='color:#6D8AC4;text-decoration:none'>Shots - Health News </span></a></span></b><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><b><span lang=EN style='font-size:13.5pt;font-family:"Georgia","serif"'><a href="https://www.npr.org/sections/health-shots/2017/03/18/519217051/my-unlovely-lady-lump-when-mrsa-is-ugly-but-not-life-threatening"><span style='color:#6D8AC4;text-decoration:none'>My Unlovely Lady Lump: When MRSA Is Ugly, But Not Life-Threatening</span></a></span></b><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Her previous research showed that patients who were carriers of<b> </b>MRSA bacteria on their skin or in their nose, for example, who, for six months, used chlorhexidine for bathing and as a mouthwash, and swabbed their noses with a nasal antibiotic were able to reduce their risk of developing a MRSA infection by 30 percent. But all the patients in that study, <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1716771"><span style='color:#6D8AC4;text-decoration:none'>published in February</span></a> in the <i>New England Journal of Medicine</i>, already had been discharged from hospitals.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Now the goal is to target patients still in hospitals or nursing homes and extend the work to CRE. The traditional hospitals participating in the new project are focusing on patients in intensive care units and those who already carry drug-resistant bacteria, while the nursing homes and the long-term acute care hospitals perform the cleaning — also called "decolonizing" — on every resident.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>One recent morning at Coventry Court Health Center, a nursing home in Anaheim, Calif., 94-year-old Neva Shinkle sat patiently in her wheelchair. Licensed vocational nurse Joana Bartolome swabbed her nose and asked if she remembered what it did.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>"It kills germs," Shinkle responded.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>"That's right — it protects you from infection."</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>In a nearby room, senior project coordinator Raveena Singh from UCI talked with Caridad Coca, 71, who had recently arrived at the facility. She explained that Coca would bathe with the chlorhexidine rather than regular soap. "If you have some kind of open wound or cut, it helps protect you from getting an infection," Singh said. "And we are not just protecting you, one person. We protect everybody in the nursing home."</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Coca said she had a cousin who had spent months in the hospital after getting MRSA. "Luckily, I've never had it," she said.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Coventry Court administrator <a href="https://www.coventrycourt.org/team-member/shaun-dahl"><span style='color:#6D8AC4;text-decoration:none'>Shaun Dahl</span></a> says he was eager to participate because people were arriving at the nursing home carrying MRSA or other bugs. "They were sick there and they are sick here," Dahl says.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>Results from the Chicago project are pending. Preliminary results of the Orange County project, which ends in May, show that it seems to be working, Huang says. After 18 months, researchers saw a 25 percent decline in drug-resistant organisms in nursing home residents, 34 percent in patients of long-term acute care hospitals and 9 percent in traditional hospital patients. The most dramatic drops were in CRE, though the number of patients with that type of bacteria was smaller.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>The preliminary data also show a promising ripple effect in facilities that aren't part of the effort, a sign that the project may be starting to make a difference in the county, says Zahn of the Orange County Health Care Agency.</span><o:p></o:p></p><p class=MsoNormal style='background:#F9F9F9'><span lang=EN style='font-size:10.5pt;font-family:"Georgia","serif"'>"In our community, we have seen an increase in antimicrobial-resistant infections," he says<b>. </b>"This offers an opportunity to intervene and bend the curve in the right direction."</span><o:p></o:p></p><p class=MsoNormal><span style='font-size:12.0pt;font-family:"Times New Roman","serif";color:#0000CC'> </span><o:p></o:p></p></div></body></html>