TABLE 3.

Recent Published Major Multisite Clinical Trials Evaluating Interventions to Prevent Healthcare-Associated Infection

Study	Study design	Intervention	Comparator	Outcome	Results	Populations	No. of centers/ sites
Bode et al66	RCT	Rapid screening for S. aureus and decolonization with topical mupirocin and chlorhexidine in hospitalized patients	Placebo	Hospital-associated S. aureus infection	Rate of hospital-associated S. aureus infection was lower in the group that received intervention	Medical and surgical patients (majority were surgical patients)	5
Bennett-Guerrer et al67	Multicenter RCT	Gentamicin-collagen sponge	Standard care	SSI in 60 days following procedure	Rate of SSI was higher with use of the sponge	Colorectal surgical patients	39 sites
Bennett-Guerrer et al68	Multicenter RCT	Gentamicin-collagen sponge	Standard care	Sternal wound infection in 60 days following procedure	No difference in rate of sternal wound infection	Cardiothoracic surgical patients	48 sites
Derde et al69	Interrupted time series RCT	6 months universal CHG bathing and hand hygiene improvement for 6 months followed by rapid screening	Conventional screening	Acquisition of resistant bacteria per 100 patient-days at risk	Reduction in resistant bacteria with improved hand hygiene and unit-wide CHG bathing. No additional reduction in acquisition with rapid testing or conventional screening and isolation of carriers.	ICU patients	13 ICUs
Harris et al59	Multicenter Cluster RCT	Universal gloves and gowns in all ICU patient contacts and when entering rooms	CDC recommendation for gloves and gowns when patients have known MRSA or VRE	Colonization acquisition rates of MRSA and VRE	No decrease the combined acquisition of MRSA and VRE, but 40% decrease in MRSA acquisition without increasing the rate of adverse events	Medical and surgical ICU patients	20 ICUs
Huskins et al70	Cluster RCT	Active surveillance for MRSA and VRE	No active surveillance	Incidence of MRSA and VRE colonization or infection	incidence of colonization or infection with MRSA or VRE per 1000 patient-days, did not differ significantly between the intervention and control ICUs	Adult ICU patients	19 ICUs
Loeb et al71	RCT	N-95 respirator	Surgical mask	Laboratory confirmed influenza	Surgical mask noninferior to N-95 respirator	ED, medical and pediatric areas	8
Rabih et al72	RCT	Chlorhexidine-alchohol skin scrub	Povidone-iodine scrub	SSI within 30 days of surgery	Lower rates of SSI in chlorhexidine-alcohol group	Adult patient undergoing clean contaminated surgery	6
Milstone et al47	Cluster RCT with crossover	Daily chlorhexidine bathing	Standard bathing practices	Bacteremia	Lower incidence of bacteremia among patients receiving daily CHG bathing	Pediatric ICU
Timsit et al73	RCT	Chlorhexidine impregnated sponge dressing and frequency of dressing changes every 7 days	Standard dressing changed at 3 days	Catheter related infection	Chlorhexidine impregnated sponge dressings decreased the rates of major catheter-related infection; dressing change frequency every 7 days did not impact catheter colonization	Adult ICUs	5 sites/7 ICUs
Timsit et al74	RCT	Chlorhexidine impregnated gel dressing and highly adherent dressing	Standard dressing	Catheter related infection	Chlorhexidine impregnated gel dressings decreased the rates of major catheter-related infection; highly adherent dressings did not impact catheter-related infection	Adult ICUs	12 ICUs
de Smet et al75	Cluster RCT with crossover	Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD)	No SDD or SOD	Survival and bacteremia	improved 28 day survival and reduced incidence of ICU acquired bacteremia in SDD/SOD group	Adults ICUs	13 ICUs
Climo et al76	Cluster RCT with crossover	Daily chlorhexidine bathing	Standard bathing practices	MRSA, VRE and bacteremia	Decreased acquisition of VRE and decreased bacteremia (primarily contaminants)	Adult ICUs	9 ICUs/6 sites
Huang et al77	Cluster RCT	Daily chlorhexidine bathing and intranasal mupiricin	Active MRSA surveillance with isolation or universal decolonization	MRSA clinical cultures and all cause bacteremia	Decreased MRSA clinical cultures and decreased bacteremias (primarily contaminants) with universal daily chlorhexidine and mupiricin	Adult ICU	74 ICUs
Pickard et al78	Cluster RCT	Silver or nitrofural-coated urinary catheters	Standard PTFE catheterization.	Symptomatic CAUTI	No clinically relevant decrease in symptomatic CAUTI with either type of impregnated catheter	Hospitalized patients	24

NOTE. CAUTI, catheter-associated urinary tract infection; ED, emergency department; ICU, intensive care unit; MRSA, methicillin-resistant Staphylococcus aureus; PTFE, polytetrafluoroethylene; RCT, randomized controlled trial; VRE, vancomycin-resistant enterococci; SDD, selective digestive tract decontamination; SOD, selective oropharyngeal decontamination.