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Babiker A, Lutgring JD, Fridkin S, Hayden MK. Assessing the Potential for Unintended Microbial Consequences of Routine Chlorhexidine Bathing for Prevention of Healthcare-associated Infections. Clin Infect Dis 2021; 72:891-898. [PMID: 32766819 PMCID: PMC8432606 DOI: 10.1093/cid/ciaa1103] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Chlorhexidine gluconate (CHG) is an antiseptic that is widely used in healthcare due to its excellent safety profile and wide spectrum of activity. Daily bathing with CHG has proven to be effective in the prevention of healthcare-associated infections and multidrug-resistant pathogen decolonization. Despite the proven benefits of CHG use, there remain concerns and unanswered questions about the potential for unintended microbial consequences of routine CHG bathing. This review aims to explore some of these questions.
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Affiliation(s)
- Ahmed Babiker
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joseph D Lutgring
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Fridkin
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary K Hayden
- Department of Internal Medicine (Infectious Diseases), Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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Comprehensive review of methicillin-resistant Staphylococcus aureus: screening and preventive recommendations for plastic surgeons and other surgical health care providers. Plast Reconstr Surg 2015; 134:1078-1089. [PMID: 25347639 DOI: 10.1097/prs.0000000000000626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Up to 2.3 million people are colonized with methicillin-resistant Staphylococcus aureus in the United States, causing well-documented morbidity and mortality. Although the association of clinical outcomes with community and hospital carriage rates is increasingly defined, less is reported about asymptomatic colonization prevalence among physicians, and specifically plastic surgeons and the subsequent association with the incidence of patient surgical-site infection. METHODS A review of the literature using the PubMed and Cochrane databases analyzing provider screening, transmission, and prevalence was undertaken. In addition, a search was completed for current screening and decontamination guidelines and outcomes. RESULTS The methicillin-resistant S. aureus carriage prevalence of surgical staff is 4.5 percent. No prospective data exist regarding transmission and interventions for plastic surgeons. No studies were found specifically looking at prevalence or treatment of plastic surgeons. Current recommendations by national organizations focus on patient-oriented point-of-care testing and intervention, largely ignoring the role of the health care provider. Excellent guidelines exist regarding screening, transmission prevention, and treatment both in the workplace and in the community. No current such guidelines exist for plastic surgeons. CONCLUSIONS No Level I or II evidence was found regarding physician screening, treatment, or transmission. Current expert opinion, however, indicates that plastic surgeons and their staff should be vigilant for methicillin-resistant S. aureus transmission, and once a sentinel cluster of skin and soft-tissue infections is identified, systematic screening and decontamination should be considered. If positive, topical decolonization therapy should be offered. In refractory cases, oral antibiotic therapy may be required, but this should not be used as a first-line strategy.
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Safdar N, O’Horo JC, Ghufran A, Bearden A, Didier ME, Chateau D, Maki DG. Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis*. Crit Care Med 2014; 42:1703-13. [PMID: 24674924 PMCID: PMC4258905 DOI: 10.1097/ccm.0000000000000319] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter-related colonization and catheter-related bloodstream infection using meta-analysis. DATA SOURCES Multiple computerized database searches supplemented by manual searches including relevant conference proceedings. STUDY SELECTION Randomized controlled trials evaluating the efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and catheter-related bloodstream infection. DATA EXTRACTION Data were extracted on patient and catheter characteristics and outcomes. DATA SYNTHESIS Nine randomized controlled trials met the inclusion criteria. Use of a chlorhexidine-impregnated dressing resulted in a reduced prevalence of catheter-related bloodstream infection (random effects relative risk, 0.60; 95% CI, 0.41-0.88, p = 0.009). The prevalence of catheter colonization was also markedly reduced in the chlorhexidine-impregnated dressing group (random effects relative risk, 0.52; 95% CI, 0.43-0.64; p < 0.001). There was significant benefit for prevention of catheter colonization and catheter-related bloodstream infection, including arterial catheters used for hemodynamic monitoring. Other than in low birth weight infants, adverse effects were rare and minor. CONCLUSIONS Our analysis shows that a chlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and, more importantly, catheter-related bloodstream infection and warrants routine use in patients at high risk of catheter-related bloodstream infection and central venous catheter or arterial catheter colonization.
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Affiliation(s)
- Nasia Safdar
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - John C. O’Horo
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Aiman Ghufran
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Allison Bearden
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Maria Eugenia Didier
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Dan Chateau
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
| | - Dennis G. Maki
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI (NS, AB, MD, DGM, AG), Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN (JCO) and the Biostatistical Consulting Unit (DC), Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.(DC)
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Prevalence of chlorhexidine-resistant methicillin-resistant Staphylococcus aureus following prolonged exposure. Antimicrob Agents Chemother 2014; 58:4404-10. [PMID: 24841265 DOI: 10.1128/aac.02419-14] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Chlorhexidine has been increasingly utilized in outpatient settings to control methicillin-resistant Staphylococcus aureus (MRSA) outbreaks and as a component of programs for MRSA decolonization and prevention of skin and soft-tissue infections (SSTIs). The objective of this study was to determine the prevalence of chlorhexidine resistance in clinical and colonizing MRSA isolates obtained in the context of a community-based cluster-randomized controlled trial for SSTI prevention, during which 10,030 soldiers were issued chlorhexidine for body washing. We obtained epidemiological data on study participants and performed molecular analysis of MRSA isolates, including PCR assays for determinants of chlorhexidine resistance and high-level mupirocin resistance and pulsed-field gel electrophoresis (PFGE). During the study period, May 2010 to January 2012, we identified 720 MRSA isolates, of which 615 (85.4%) were available for molecular analysis, i.e., 341 clinical and 274 colonizing isolates. Overall, only 10 (1.6%) of 615 isolates were chlorhexidine resistant, including three from the chlorhexidine group and seven from nonchlorhexidine groups (P > 0.99). Five (1.5%) of the 341 clinical isolates and five (1.8%) of the 274 colonizing isolates harbored chlorhexidine resistance genes, and four (40%) of the 10 possessed genetic determinants for mupirocin resistance. All chlorhexidine-resistant isolates were USA300. The overall prevalence of chlorhexidine resistance in MRSA isolates obtained from our study participants was low. We found no association between extended chlorhexidine use and the prevalence of chlorhexidine-resistant MRSA isolates; however, continued surveillance is warranted, as this agent continues to be utilized for infection control and prevention efforts.
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