Universal vs Targeted Chlorhexidine Bathing and Nasal Decolonization in Hospitalized Patients.

Summary

Using a decision-analytic model informed by the cluster-randomized ABATE trial, targeted chlorhexidine bathing and nasal decolonization for patients with medical devices was cost-effective from both payer and hospital perspectives across broad scenarios. Universal decolonization minimized HOB events but required higher incremental costs per event averted and may be preferable only in high-device or low-adherence settings.

Key Findings

• In the base case, standard of care was least effective and most costly; targeted decolonization was least costly.
• Universal decolonization achieved the fewest HOB events but had ICERs of $119,700 (payer) and $126,600 (hospital) per HOB averted versus targeted.
• Targeted decolonization was cost-effective across broad scenarios; universal may be preferred in high device-prevalence units or with low targeted adherence.

Clinical Implications

Adopt targeted decolonization for general medical/surgical units as the default, reserving universal decolonization for high-device units or when targeted adherence is poor; align infection prevention with payer and hospital willingness-to-pay thresholds.

Limitations

• Model outcomes depend on assumptions (adherence, costs, effect sizes) and willingness-to-pay thresholds
• Generalizability may vary by unit case mix and implementation fidelity

Future Directions

Prospective implementation studies comparing targeted vs universal strategies by unit type, with real-world adherence, resistance ecology, and equity outcomes.