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Recognizing bacterial colonization vs. infection in long-term care residents

While long-term care facilities are designed to meet a person’s health and personal care needs, residents have an increased infection risk.1 Understanding the difference between bacterial colonization and infection can help support better decision-making for residents in long-term care.

FROM BACTERIAL COLONIZATION TO INFECTION

 Bacterial colonization is the presence of microorganisms in or on a carrier or host with growth and multiplication, but without tissue invasion or damage.2 A carrier is an individual who serves as a potential source of infection. Carriers can be a source of infection when symptomatic during active infections, and even while asymptomatic during colonization, incubation before active disease and when recovering from an acute disease.2

For residents living in long-term care facilities like nursing homes or assisted living, the risk of bacterial colonization and healthcare-associated infection (HAI) increases. Common causes of colonization include methicillin-resistant Staphylococcus aureus, C. difficile, and vancomycin-resistant Enterococcus.1

Bacterial colonization can spread in different ways:

  • Interacting with healthcare providers, and direct contact with their hands
  • Close contact with other potentially colonized residents3
  • Contaminated surfaces3
  • Open wounds such as pressure ulcers3
  • Surgery4

 

RECOGNIZING THE DIFFERENCE

RECOGNIZING THE DIFFERENCE 

When bacterial colonization replicates in the host tissue, an infection can occur and develop into an active infectious process, depending on the virility of the infectious agent or pathogen. Misdiagnosing colonization as an infection can lead to unnecessary antibiotic use, antibiotic resistance and increased cost. Some infected patients may be asymptomatic or have a subclinical infection, meaning they may not show any signs of infection.5

Because the microbiome greatly influences health and well-being, recognizing the differences between bacterial colonization and infection is essential when planning and implementing effective infection prevention strategies such as screening, antibiotic stewardship, using CHG products like HibiClens® 4% CHG skin cleanser or rinse-based CHG products, and CHG skin cleansing protocols.2

 

Screening

SCREENING

Screening residents is an integral component to early identification of asymptomatic colonization, which prompts initiation of infection prevention and control measures focused on reducing transmission to other residents. Several factors that influence who, when and how often to screen include the local epidemiology, identified links to other cases and patient risk factors.6

 

ANTIBIOTIC STEWARDSHIP

ANTIBIOTIC STEWARDSHIP

While antibiotics are effective in infection treatment, unnecessary antibiotic use can greatly affect the health and well-being of long-term care residents. A recent study by Cohen and Dick (2020) found that 1.1 to 2.7 million infections occur annually among nursing home residents, with 40-70% of antibiotic usage as unnecessary without documented bacterial infection.7 The Centers for Disease Control and Prevention (CDC) recommends implementing antibiotic stewardship to improve antibiotic prescribing practices through leadership commitment, accountability, drug expertise, action, tracking, reporting and education.8

 

ANTIBACTERIAL SURGICAL SKIN CLEANSER

ANTIBACTERIAL SURGICAL SKIN CLEANSER

4% Chlorhexidine gluconate solutions like HibiClens® is a gentle, yet powerful antiseptic known to reduce the risk of HAIs and SSIs by killing bacteria, fungi, and viruses. It forms a protective layer on the patient’s skin to reduce bio-burden of microorganisms’ immediately after application and hours after use.9,10 Implementing standard bathing protocols with HibiClens® can significantly reduce the microbial density on the skin.

 

BATHING WITH 4% CHG SKIN CLEANSING PROTOCOLS

BATHING WITH 4% CHG SKIN CLEANSING PROTOCOLS

In long-term care settings, HAIs and multidrug-resistant organisms (MDROs) remain major challenges. In 2020, Elizabeth Gall, Kendall Hall and Anna Long summarized multiple studies that revealed a high level of evidence supporting chlorhexidine bathing in the reduction of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and carbapenem-resistant Enterobacteriaceae acquisition.10 Implementing routine bathing with 4% CHG skin cleansers can be a useful protocol in infection prevention and control, particularly when the goal is to reduce HAIs and MDROs.11

Health care professional holding patient's hand

Understanding the difference

between bacterial colonization and infection is critical in long-term care residents’ health and wellbeing. With the right prevention strategies in place, healthcare teams can help reduce infection risk, preserve antibiotic effectiveness, and ensure quality healthcare for every patient, every day.

 

For more information and educational resources regarding infection risk mitigation, visit Molnlycke.com/us-en/solutions/Hibi or contact us at HibiUS@Molnlycke.com

 

MHC-2026-001125

    1. Infection prevention and long-term care facility residents. (2024b). Retrieved from https://www.cdc.gov/long-term-care-facilities/about/index.html.
    2. N.d.). Retrieved from https://ldh.la.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/HAI/MDRO2017/handouts/ColonizationvInfection.pdf.
    3. Long-Term Care. (2024a). Retrieved from https://www.sepsis.org/sepsisand/sepsis-long-term-care/.
    4. Mangalea, M. R., Halpin, A. L., Haile, M., Elkins, C. A., & McDonald, L. C. (2024). Decolonization and pathogen reduction approaches to prevent antimicrobial resistance and healthcare-associated infections. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC11138981/.
    5. Colonization vs Infection: Multi-Drug-Resistant Organisms Management in Long Term Care Facilities Workshop. (n.d.). Retrieved from https://ldh.la.gov/assets/oph/Center-PHCH/Center-CH/infectious-epi/HAI/MDRO2017/handouts/ColonizationvInfection.pdf.
    6. Screening recommendations for Healthcare Facilities. (2025c). Retrieved from https://www.cdc.gov/candida-auris/hcp/screening-hcp/index.html.
    7. Cohen, C. C., Dick, A. W., Agarwal, M., Gracner, T., Mitchell, S., & Stone, P. W. (2020). Trends in antibiotics use among long-term US nursing-home residents: Infection Control & Hospital epidemiology. Retrieved from https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/trends-in-antibiotics-use-among-longterm-us-nursinghome-residents/52A2BE24A8FF3867D1369A8C5B3339EC.
    8. Core elements of antibiotic stewardship. (2024b). Retrieved from https://www.cdc.gov/antibiotic-use/hcp/core-elements/nursing-homes-antibioticstewardship.html?CDC_AAref_Val=https://www.cdc.gov/antibiotic-use/core-elements/nursing-homes.html.
    9. 9. Mölnlycke Internal Report REPR 1037. Gall, E., Long, A., & Hall, K. (2020). Chlorhexidine Bathing Strategies for Multidrug-Resistant Organisms: A Summary of Recent Evidence. Retrieved from https://www.ovid.com/jnls/journalpatientsafety/fulltext/10.1097/pts.0000000000000743~chlorhexidine-bathing-strategies-for-multidrug-resistant.
    10. Celik, G. H. T. (2026). Chlorhexidine Bathing in Infection

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