Antiseptic Decolonization for Surgical Site Infections

(DECREASE SSI Trial)

Recruiting at 3 trial locations

Overseen By Raveena Singh, MA

Age: 18+

Sex: Any

Trial Phase: Phase 4

Sponsor: University of California, Irvine

Must not be taking: Systemic antibacterials

Disqualifiers: Acute care, Hospice, Allergies, others

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: Unknown

Duration: 4 weeks

2700 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if an antiseptic body wash and nasal ointment can reduce the risk of infections at surgical sites after hospital discharge. Participants will use either a special antiseptic soap and antibiotic nasal ointment or a regular soap and placebo ointment. The study targets individuals who have recently undergone open colon or small bowel surgery and can care for themselves or have assistance with bathing. As a Phase 4 trial, this research seeks to understand how an already FDA-approved and effective treatment can benefit more patients.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify if you need to stop taking your current medications. However, if you have an active infection requiring systemic antibacterial agents, you may be excluded from participating.

What is the safety track record for 2% Mupirocin and 4% Chlorhexidine Gluconate?

Research has shown that using a nasal antibiotic ointment called mupirocin with an antiseptic soap called chlorhexidine gluconate is generally safe for patients. Studies confirm that this combination effectively reduces infections at surgical sites. Mupirocin is safe when applied inside the nose twice a day for five days, and chlorhexidine is well-tolerated when used on the skin.

Some people might experience mild skin irritation or a burning sensation from these treatments, but serious side effects are rare. Hospitals often use this combination to prevent infections after surgery. It helps kill bacteria that can cause infections, making it a valuable tool for keeping surgical sites clean and reducing the risk of complications. ^{1 2 3 4 5}

Why are researchers enthusiastic about this study treatment?

Researchers are excited about this trial because it explores a promising approach to reducing surgical site infections through antiseptic decolonization. Unlike typical methods that rely on standard soap and regular nasal ointments, this trial combines a chlorhexidine body wash with nasal mupirocin, an antibiotic ointment. This combination targets harmful bacteria more effectively, potentially lowering infection rates and improving surgical outcomes. By addressing bacteria both on the skin and in the nasal passages, this approach could offer a more comprehensive infection prevention strategy than current standard care options.

What evidence suggests that this trial's treatments could be effective for reducing surgical site infections?

Research shows that using a chlorhexidine body wash and nasal mupirocin can help reduce infections after surgery. In this trial, participants in the Decolonization arm will use this combination. A review of several studies has found that cleaning the skin with chlorhexidine before surgery results in fewer infections compared to other methods. Studies also indicate that chlorhexidine lowers infection rates in various surgeries, including those with a higher risk of contamination. When used together, mupirocin and chlorhexidine further reduce infections in surgical patients. Moderate-quality evidence supports this combination for preventing infections after surgery. Participants in the Routine Care arm will use soap without antiseptic properties and a placebo nasal ointment. ^{3 6 7 8 9}

Who Is on the Research Team?

Susan Huang, MD, MPH

Principal Investigator

University of California, Irvine

Deborah Yokoe, MD, MPH

Principal Investigator

University of California, San Francisco

Stuart Cohen, MD

Principal Investigator

University of California, Davis

Are You a Good Fit for This Trial?

This trial is for adults who've had recent open surgery on their colon or small bowel, can bathe themselves or have help doing so, and are able to talk on the phone. It's not for those with an active infection at enrollment, unclosed surgical incisions, transferred to acute care hospitals post-surgery, discharged more than 14 days after surgery, in end-of-life hospice care, or allergic to mupirocin/chlorhexidine.

Inclusion Criteria

I can bathe myself or have someone to help me.

I can make regular phone calls.

I had recent open surgery involving my abdomen or a C-section with a BMI ≥ 40.

Exclusion Criteria

Discharged to receive end-of-life hospice measures

Allergic to mupirocin and/or chlorhexidine

I do not have an active infection needing antibiotics at enrollment.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either chlorhexidine bathing plus nasal mupirocin or placebo for 30 days following discharge

4 weeks

Follow-up

Participants are monitored for surgical site infection and other outcomes after treatment

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• 2% Mupirocin
• 4% Chlorhexidine Gluconate
• Placebo Nasal Ointment
• Soap Without Antiseptic Properties (Placebo)

Trial Overview The DECREASE SSI Trial is testing if bathing with chlorhexidine and using nasal mupirocin for 30 days after discharge can reduce infections compared to using regular soap (placebo) and placebo nasal ointment in patients who've undergone certain bowel surgeries.

How Is the Trial Designed?

Group I: Decolonization Active Control 2 Interventions

Participants randomized into this arm will perform decolonization using topical antiseptic soap (chlorhexidine body wash) and an antibiotic ointment (nasal mupirocin).

Group II: Routine Care Placebo Group 2 Interventions

Participants randomized into this arm will perform routine care using soap without antiseptic properties (placebo) and placebo nasal ointment.

Placebo Nasal Ointment is already approved in United States, European Union for the following indications:

Approved in United States as Placebo Nasal Ointment for:

• Clinical trial control substance

Approved in European Union as Placebo Nasal Ointment for:

• Clinical trial control substance

Who Is Running the Clinical Trial?

University of California, Irvine

Lead Sponsor

Trials

580

Recruited

4,943,000+

Hoag Memorial Hospital Presbyterian

Collaborator

Trials

37

Recruited

17,200+

University of California, San Francisco

Collaborator

Trials

2,636

Recruited

19,080,000+

University of California, Davis

Collaborator

Trials

958

Recruited

4,816,000+

University of Massachusetts, Amherst

Collaborator

Trials

83

Recruited

3,474,000+

Published Research Related to This Trial

Olanexidine gluconate demonstrated superior bactericidal efficacy compared to chlorhexidine and povidone-iodine when applied to blood-contaminated skin, making it a promising option for preoperative skin preparation.

In non-blood-contaminated conditions, olanexidine's effectiveness was comparable to that of established antiseptics, indicating its potential as a reliable antiseptic for surgical use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of olanexidine gluconate on preoperative skin preparation: an experimental study in cynomolgus monkeys. Nakata, H., Tsubotani, Y., Nii, T., et al.[2019]

In a study of 120 patients undergoing nasal surgery, the use of xylometazoline hydrochloride 0.1% nasal spray did not provide better symptom relief compared to sterile physiological saline aerosol.

Patients using xylometazoline reported significantly higher pain scores post-operatively, suggesting that it may not be a safe or effective option for managing symptoms after nasal surgery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Xylometazoline hydrochloride 0.1 per cent versus physiological saline in nasal surgical aftercare: a randomised, single-blinded, comparative clinical trial. Humphreys, MR., Grant, D., McKean, SA., et al.[2015]

Nasal decolonization using mupirocin combined with chlorhexidine body wash significantly reduces the incidence of S. aureus-related surgical site infections in patients who are carriers, particularly in various surgical procedures, indicating its efficacy as a targeted intervention.

Universal nasal decolonization is more cost-effective than targeted approaches, potentially saving the healthcare system approximately $45.08 million over five years, while targeted decolonization may increase costs despite its benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pre-surgical Nasal Decolonization of Staphylococcus aureus: A Health Technology Assessment. [2022]

Implementing a comprehensive nasal decolonization protocol, which included a nonantibiotic alcohol-based antiseptic and chlorhexidine, significantly reduced surgical site infection rates in spine surgery patients by 81%.

The trial lasted 15 months and showed a decrease in infection rates from 1.76 to 0.33 per 100 surgeries, highlighting the effectiveness of this combined approach in improving patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Perioperative participation of orthopedic patients and surgical staff in a nasal decolonization intervention to reduce Staphylococcus spp surgical site infections. Mullen, A., Wieland, HJ., Wieser, ES., et al.[2022]

Implementing preoperative universal nasal and skin decolonization using an alcohol-based nasal antiseptic and chlorhexidine bathing significantly reduced surgical site infection rates after total joint replacement procedures.

This intervention not only decreased patient morbidity but also lowered healthcare costs associated with treating infections, highlighting its efficacy and potential benefits in surgical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A safer, less costly SSI prevention protocol-Universal versus targeted preoperative decolonization. Franklin, S.[2021]

Pre-operative decolonization with octenidine (OCT) did not significantly reduce overall surgical site infection (SSI) rates in patients undergoing elective coronary artery bypass graft (CABG) surgery, with rates of 15.4% in the control group and 13.3% in the intervention group.

However, the intervention significantly lowered the rate of harvest site SSIs (2.5% vs 0.5%) and organ/space sternal SSIs (1.9% vs 0.3%), indicating some targeted benefits of OCT in specific infection types.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery. Reiser, M., Scherag, A., Forstner, C., et al.[2021]

Nasal decontamination significantly reduces the risk of surgical site infections (SSIs) in Staphylococcus aureus carriers, particularly in patients undergoing pulmonary surgeries, based on a review of 20 randomized controlled trials involving over 10,500 patients.

Chlorhexidine was found to be effective in decreasing SSI rates (RR = 0.474), while mupirocin did not show a significant benefit, indicating that the choice of decontamination method can impact surgical outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nasal decolonization of Staphylococcus aureus and the risk of surgical site infection after surgery: a meta-analysis. Tang, J., Hui, J., Ma, J., et al.[2021]

In a study involving 614 patients, mupirocin nasal ointment was highly effective in eradicating Staphylococcus aureus nasal carriage, achieving an eradication rate of 83.5% compared to 27.8% in the placebo group.

Despite the successful eradication of nasal carriage, mupirocin did not significantly reduce the overall rate of surgical site infections (SSIs) or the length of hospital stays, indicating that while it may help with nasal carriage, it does not necessarily prevent SSIs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Kalmeijer, MD., Coertjens, H., van Nieuwland-Bollen, PM., et al.[2013]

Many skin antiseptics used in healthcare settings are sold as nonsterile and can be contaminated with harmful microorganisms, potentially leading to healthcare-associated infections.

There is a need to include skin antiseptics in antibiotic stewardship programs to mitigate the risk of contamination and the development of antimicrobial resistance, especially in hospitalized patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Skin antiseptics in healthcare facilities: is a targeted approach necessary? Wiemken, TL.[2020]

In a study of 1989 patients, preoperative washing with chlorhexidine significantly reduced the overall incidence of postoperative wound infections to 9%, compared to 12.8% with bar soap and 11.7% with a placebo.

For 'clean' surgeries, chlorhexidine further decreased the infection rate to 7.2%, and specifically reduced Staphylococcus aureus infections to 3%, highlighting its efficacy in preventing infections compared to traditional washing methods.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A placebo-controlled trial of the effect of two preoperative baths or showers with chlorhexidine detergent on postoperative wound infection rates. Hayek, LJ., Emerson, JM., Gardner, AM.[2019]

In a 9-week double-blind study involving 50 patients with moderately severe atopic dermatitis, daily bathing with an antibacterial soap containing 1.5% triclocarban significantly improved skin lesions compared to a placebo soap.

The use of the antibacterial soap not only led to clinical improvements but also reduced the levels of Staphylococcus aureus and total aerobic organisms on the skin, indicating its efficacy in managing atopic dermatitis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of antibacterial soap with 1.5% triclocarban on Staphylococcus aureus in patients with atopic dermatitis. Breneman, DL., Hanifin, JM., Berge, CA., et al.[2013]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9495544/

Implementation of a surgical site infection prevention bundle However, 86% of patients were fully adherent with CHG bathing and only 53% were fully adherent with mupirocin. A previous survey of a ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S2950198925000479

Strategies to reduce the risk of surgical site infections ... In a meta-analysis involving 6916 patients (derived from 4 RCTs), surgical site preparation with chlorhexidine gluconate and alcohol produced lower rates of ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8499511/

Effectiveness of chlorhexidine in preventing infections among ... CHX is associated with reduced postoperative surgical site infections (SSI) compared with povidone-iodine in clean-contaminated surgery [16].

4. aricjournal.biomedcentral.com aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0568-5

A cost-effectiveness analysis of mupirocin and chlorhexidine ... Advance pre-operative chlorhexidine reduces the incidence of surgical site infections in knee arthroplasty. Int Orthop. 2011;35:1001–6 ...

5. cdn.who.int cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/ssi/evidence/appendix3.pdf?sfvrsn=5e78dae0_2

WHO Surgical Site Infection Prevention Guidelines Overall, a moderate quality of evidence shows that the use of mupirocin 2% ointment in combination with or without CHG body wash in surgical patients with nasal ...

6. ncbi.nlm.nih.gov ncbi.nlm.nih.gov/books/NBK536431/

Global Guidelines for the Prevention of Surgical Site Infection Mupirocin nasal ointment (usually applied to the nose 2 times daily for 5 days) is an effective, safe and relatively cheap treatment for the eradication of ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC4668802/

Preventing Surgical Site Infections: A Randomized, Open ... The regimen of nasal mupirocin ointment and topical chlorhexidine gluconate is effective, but cost and patient compliance may be a barrier.

8. jaadreviews.org jaadreviews.org/article/S2950-1989(25)00047-9/fulltext

Strategies to reduce the risk of surgical site infections ... Interventions that may reduce the risk of surgical site infection include avoiding razor for hair removal, decolonization with antistaphylococcal agents and ...

9. dhs.wisconsin.gov dhs.wisconsin.gov/publications/p01715.pdf

DHS SSI Guidance, P-01715 Safety and tolerability of chlorhexidine gluconate (2%) as a vaginal preparation in patients undergoing gynecologic surgery. Am J Infect Control ...