Nursing Home Infections: Can Antiseptic Treatments Help?

Why Does Antibiotic Resistance Make Infection Prevention More Important?

The CDC's COVID-19 and antimicrobial resistance overview, updated in February 2025, describes a substantial reversal in hospital infection prevention during the pandemic. Resistant hospital-onset infections and deaths increased by at least 15% between 2019 and 2020 across seven pathogens. These are historical findings, rather than newly released October figures. The agency identifies longer hospital stays, greater use of invasive devices, disrupted prevention practices and antibiotic exposure as contributing pressures. [CDC overview](https://www.cdc.gov/antimicrobial-resistance/data-research/threats/COVID-19.html)

One prevention approach targets colonization: potentially harmful bacteria living on or in the body without causing symptoms. Those organisms can subsequently cause infection or spread to others. Decolonization aims to reduce that bacterial burden. For vulnerable residents, this creates an opportunity to intervene before an infection requires systemic treatment. A 2024 review by CDC researchers explains how reducing pathogen carriage could benefit both individuals and the wider healthcare population. [CDC researchers' review](https://wwwnc.cdc.gov/eid/article/30/6/23-1338_article)

What Did the Nursing Home Antiseptic Trial Find?

Published in the New England Journal of Medicine in 2023, Protect randomly assigned nursing homes to routine care or a facility-wide prevention program. Intervention facilities used chlorhexidine during routine bathing and administered nasal povidone-iodine on a recurring schedule. The study compared changes from an 18-month baseline with those during an 18-month intervention. [Protect trial](https://www.nejm.org/doi/full/10.1056/NEJMoa2215254)

The combined regimen reduced infection-related hospital transfers. Because facilities received both products, the results do not establish each product's separate contribution. The trial supports prevention in nursing homes; it does not demonstrate that antiseptics treat established infections or prevent COVID-19. Staff training accompanied implementation, an important consideration when interpreting how the program might work elsewhere. [Trial methods and findings](https://www.nejm.org/doi/full/10.1056/NEJMoa2215254)

How Should Care Facilities Balance Benefits and Safety?

Decolonization belongs within a broader prevention program that includes hand hygiene, equipment cleaning and appropriate antibiotic prescribing. The CDC emphasizes that developing new drugs alone cannot solve antimicrobial resistance; preventing infections is also essential. The practical implication is that facilities should assess whether they can deliver and monitor an antiseptic program consistently while maintaining those other protections. [CDC prevention priorities](https://www.cdc.gov/antimicrobial-resistance/data-research/threats/COVID-19.html)

Product safety matters even when an antiseptic is available without a prescription. The FDA warns that chlorhexidine can cause rare but serious allergic reactions and advises clinicians to ask about previous reactions to antiseptics. Symptoms such as breathing difficulty or facial swelling require immediate medical attention. Families should discuss a proposed regimen with the care team rather than introduce products independently, particularly when residents have a history of reactions. [FDA chlorhexidine safety communication](https://www.fda.gov/media/102986/download)