Decolonization and decontamination: what's their role in infection control?
OBJECTIVE
Hospital-acquired infections cause up to 19% of infections in paediatric patients contributing to the spread of antimicrobial resistance. This review evaluates the effect of decolonization and decontamination in hospitalized children and neonates as an adjunct to standard infection control measures.


RESULTS
Few studies on decolonization and decontamination are available in children. The evidence about the effectiveness of daily chlorhexidine washcloths on bacteraemia in paediatric patients relies on a single randomized controlled trial, in neonates with central venous access in a single retrospective observational study. It is uncertain whether nasal mupirocin reduces methicillin-resistant Staphylococcus aureus carriage and infections in neonates, whereas oral chlorhexidine mouthwashes have not proven effective in children in intensive care settings. Scanty evidence demonstrates a reduction in the rate of ventilation-acquired pneumonia with digestive tract decontamination in paediatric patients and no studies are available in neonates. These strategies have not been extensively tested in resource-poor countries.


CONCLUSIONS
Strong evidence about the efficacy of decolonization and decontamination interventions exists in adult medicine but not in paediatric patients. There is an urgent need to understand how these interventions could be adapted to neonates and resource-poor settings in which the prevalence of hospital-acquired infections is higher.
Institute for Infection and Immunity, Paediatric Infectious Diseases Research Group, St. Georges University of London, London, UK.
Stefania
S
Vergnano
D000281:Administration, Intranasal; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D002710:Chlorhexidine / Q000627:therapeutic use; D003428:Cross Infection / Q000517:prevention & control*; D003666:Decontamination / Q000379:methods; D004064:Digestive System / Q000382:microbiology*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development; D016712:Mupirocin / Q000627:therapeutic use; D009296:Nasal Cavity / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D016712:Mupirocin; D002710:Chlorhexidine