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Rhee Y, Hayden MK, Schoeny M, Baker AW, Baker MA, Gohil S, Rhee C, Talati NJ, Warren DK, Welbel S, Lolans K, Bahadori B, Bell PB, Bravo H, Dangana T, Fukuda C, Bach TH, Nelson A, Simms AT, Tolomeo P, Wolf R, Yelin R, Lin MY. Impact of measurement and feedback on chlorhexidine gluconate bathing among intensive care unit patients: A multicenter study. Infect Control Hosp Epidemiol 2023; 44:1375-1380. [PMID: 37700540 PMCID: PMC10859163 DOI: 10.1017/ice.2023.177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs). DESIGN A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods). SETTING The study was conducted across 7 geographically diverse ICUs with routine CHG bathing. PARTICIPANTS Adult patients in the medical ICU. METHODS CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations. RESULTS We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions (P < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions (P < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline (P < .001). CONCLUSIONS Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.
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Affiliation(s)
- Yoona Rhee
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Mary K. Hayden
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Michael Schoeny
- Department of Community, Systems, and Mental Health Nursing, College of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Arthur W. Baker
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Meghan A. Baker
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Shruti Gohil
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Chanu Rhee
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Naasha J. Talati
- Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David K. Warren
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Sharon Welbel
- Division of Infectious Diseases, Cook County Health, Chicago, Illinois
| | - Karen Lolans
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Bardia Bahadori
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
| | - Pamela B. Bell
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Heilen Bravo
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Thelma Dangana
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Christine Fukuda
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Tracey Habrock Bach
- Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
| | - Alicia Nelson
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Andrew T. Simms
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Pam Tolomeo
- Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert Wolf
- Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
| | - Rachel Yelin
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
| | - Michael Y. Lin
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
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Coia JE, Wilson JA, Bak A, Marsden GL, Shimonovich M, Loveday HP, Humphreys H, Wigglesworth N, Demirjian A, Brooks J, Butcher L, Price JR, Ritchie L, Newsholme W, Enoch DA, Bostock J, Cann M, Wilson APR. Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2021; 118S:S1-S39. [PMID: 34757174 DOI: 10.1016/j.jhin.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Affiliation(s)
- J E Coia
- Department of Clinical Microbiology, Hospital South West Jutland, Esbjerg, Denmark; Department of Regional Health Research IRS, University of Southern Denmark, Denmark; Healthcare Infection Society, London, UK
| | - J A Wilson
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - A Bak
- Healthcare Infection Society, London, UK.
| | | | - M Shimonovich
- Healthcare Infection Society, London, UK; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - H P Loveday
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - H Humphreys
- Healthcare Infection Society, London, UK; Department of Clinical Microbiology, The Royal College of Surgeons, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - N Wigglesworth
- Infection Prevention Society, Seafield, UK; East Kent Hospitals University, NHS Foundation Trust, Canterbury, UK
| | - A Demirjian
- Healthcare-associated Infection and Antimicrobial Resistance, Public Health England, London, UK; Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J Brooks
- Infection Prevention Society, Seafield, UK; University Hospital Southampton NHS Foundation Trust, UK
| | - L Butcher
- Infection Prevention Society, Seafield, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - J R Price
- Healthcare Infection Society, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - L Ritchie
- Healthcare Infection Society, London, UK; NHS England and NHS Improvement, London, UK
| | - W Newsholme
- Healthcare Infection Society, London, UK; Guy's and St Thomas' NHS Foundation Trust, UK
| | - D A Enoch
- Healthcare Infection Society, London, UK; Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke's Hospital, Cambridge, UK
| | | | - M Cann
- Lay Member, UK; MRSA Action UK, Preston, UK
| | - A P R Wilson
- Healthcare Infection Society, London, UK; University College London Hospitals NHS Foundation Trust, UK.
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3
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Suh JW, Kim NH, Lee MJ, Lee SE, Chun BC, Lee CK, Lee J, Kim JH, Kim SB, Yoon YK, Sohn JW, Kim MJ. Real-world experience of how chlorhexidine bathing affects the acquisition and incidence of vancomycin-resistant enterococci (VRE) in a medical intensive care unit with VRE endemicity: a prospective interrupted time-series study. Antimicrob Resist Infect Control 2021; 10:160. [PMID: 34758880 PMCID: PMC8579179 DOI: 10.1186/s13756-021-01030-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 10/25/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Critically ill patients in intensive care units (ICUs) often acquire opportunistic infections or are colonized by vancomycin-resistant enterococci (VRE), which limits therapeutic options and results in high case-fatality rates. In clinical practice, the beneficial effects of universal chlorhexidine gluconate (CHG) bathing on the control of VRE remain unclear. This study aimed to investigate whether 2% CHG daily bathing reduced the acquisition of VRE in the setting of a medical ICU (MICU) with VRE endemicity. METHODS This quasi-experimental intervention study was conducted in a 23-bed MICU of a tertiary care hospital in Korea from September 2016 to December 2017. In a prospective, interrupted time-series analysis (ITS) with a 6-month CHG bathing intervention, we compared the acquisition and incidence of VRE and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) between the pre-intervention and intervention periods. The primary and secondary outcomes were a change in the acquisition of VRE and incidence of VRE, MRSA, or CRAB between the two periods, respectively. RESULTS All the adult patients admitted to the MICU were enrolled in the pre-intervention (n = 259) and intervention (n = 242). The overall CHG daily bathing compliance rate was 72.5%. In the ITS, there was a significant intervention effect with a 58% decrease in VRE acquisition (95% CI 7.1-82.1%, p = 0.038) following the intervention. However, there was no significant intervention effects on the incidence trend of VRE, MRSA, and CRAB determined by clinical culture between the pre-intervention and intervention periods. CONCLUSION In this real-world study, we concluded that daily bathing with CHG may be an effective measure to reduce VRE cross-transmission among patients in MICU with a high VRE endemicity.
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Affiliation(s)
- Jin Woong Suh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea
| | - Nam Hee Kim
- Infection Control Unit, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Min Jung Lee
- Infection Control Unit, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seoung Eun Lee
- Infection Control Unit, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Byung Chul Chun
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyu Lee
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Juneyoung Lee
- Department of Medical Statistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.,Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea.,Division of Infectious Diseases, Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.,Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.,Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.,Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea. .,Infection Control Unit, Korea University Anam Hospital, Seoul, Republic of Korea. .,Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea. .,Institute of Emerging Infectious Diseases, Korea University, Seoul, Republic of Korea.
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4
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Chapman L, Hargett L, Anderson T, Galluzzo J, Zimand P. Chlorhexidine Gluconate Bathing Program to Reduce Health Care-Associated Infections in Both Critically Ill and Non-Critically Ill Patients. Crit Care Nurse 2021; 41:e1-e8. [PMID: 34595499 DOI: 10.4037/ccn2021340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care-associated infections, which affect patients' lives and health care systems in various ways. OBJECTIVE To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care-associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. METHODS A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care-associated infections. RESULTS Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care-associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care-associated infections. CONCLUSION A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care-associated infections in intensive care unit and non-intensive care unit hospital settings.
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Affiliation(s)
- Leigh Chapman
- Leigh Chapman is the director of surgical nursing, rehabilitation, and vascular access, University of Maryland St. Joseph Medical Center, Towson, Maryland
| | - Lisa Hargett
- Lisa Hargett is the director of infection prevention, University of Maryland St. Joseph Medical Center
| | - Theresa Anderson
- Theresa Anderson is a senior coordinator for infection prevention, University of Maryland St. Joseph Medical Center
| | - Jacqueline Galluzzo
- Jacqueline Galluzzo is an infection preventionist, University of Maryland St. Joseph Medical Center
| | - Paul Zimand
- Paul Zimand is a data scientist, University of Maryland Medical System, Baltimore, Maryland
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5
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Abstract
Staphylococcus aureus infections are associated with increased morbidity, mortality, hospital stay, and health care costs. S aureus colonization has been shown to increase risk for invasive and noninvasive infections. Decolonization of S aureus has been evaluated in multiple patient settings as a possible strategy to decrease the risk of S aureus transmission and infection. In this article, we review the recent literature on S aureus decolonization in surgical patients, patients with recurrent skin and soft tissue infections, critically ill patients, hospitalized non-critically ill patients, dialysis patients, and nursing home residents to inform clinical practice.
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Affiliation(s)
- Sima L Sharara
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Lisa L Maragakis
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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6
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Chan AK, Mummaneni PV. In Reply: Chlorhexidine Showers Are Associated With a Reduction in Surgical Site Infection Following Spine Surgery: An Analysis of 4266 Consecutive Surgeries. Neurosurgery 2020; 86:E581-E582. [PMID: 32022231 DOI: 10.1093/neuros/nyaa032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Andrew K Chan
- Department of Neurological Surgery University of California, San Francisco San Francisco, California, United States
| | - Praveen V Mummaneni
- Department of Neurological Surgery University of California, San Francisco San Francisco, California, United States
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7
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Use of a simple colorimetric assay to provide monitoring and feedback on adherence to chlorhexidine bathing protocols. Am J Infect Control 2020; 48:469-470. [PMID: 31864806 DOI: 10.1016/j.ajic.2019.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022]
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Abstract
Application of antiseptic products to the skin plays an important role in prevention of a variety of health care-associated infections. Preoperative bathing or showering is widely recommended to reduce the risk of surgical site infections. Evidence of the impact of this measure on surgical site infection rates is mixed, and further prospective trials comparing standardized protocols for showering with plain soap or chlorhexidine gluconate (CHG)-containing soap, or bathing with 2% CHG-impregnated cloths are needed to establish the most effective approach. Current evidence favors the use of alcohol-containing solutions, often containing CHG or povidone-iodine, for surgical site preparation of the skin. Preparation of vaginal mucosa prior to gynecologic surgery may be performed using either povidone-iodine or CHG. Surgical hand antisepsis can be performed by scrubbing with an antimicrobial soap or by handrubbing using an alcohol-based handrub. Addition of CHG to alcohol-based handrubs intended for surgical hand antisepsis is not necessary if they meet recommended efficacy criteria. Daily CHG bathing of intensive care unit patients has been shown to reduce a variety of health care-associated infections, most commonly bloodstream infections (BSIs). Achieving and maintaining optimum application protocols may be challenging, suggesting the need for ongoing staff education, monitoring, and feedback. Additional studies are needed to determine the impact of daily CHG bathing of non-intensive care unit patients. Alcoholic CHG is currently the preferred antiseptic for skin preparation prior to insertion of central and arterial intravascular catheters. CHG-impregnated dressings have been shown to reduce catheter-associated BSI. Because of the widespread use of antiseptics, especially CHG, surveillance for emergence of increased tolerance or resistance is warranted. Antiseptics are applied to the skin for a variety of purposes in health care. Common scenarios in which topical antiseptics are used include preoperative bathing, surgical site preparation, surgical hand hygiene, daily bathing of intensive care unit patients, and prevention of intravascular catheter-associated BSI. The purpose of this article is to review recent evidence regarding the best products for skin antisepsis.
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9
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Huang SS, Septimus E, Kleinman K, Moody J, Hickok J, Heim L, Gombosev A, Avery TR, Haffenreffer K, Shimelman L, Hayden MK, Weinstein RA, Spencer-Smith C, Kaganov RE, Murphy MV, Forehand T, Lankiewicz J, Coady MH, Portillo L, Sarup-Patel J, Jernigan JA, Perlin JB, Platt R. Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial. Lancet 2019; 393:1205-1215. [PMID: 30850112 PMCID: PMC6650266 DOI: 10.1016/s0140-6736(18)32593-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/28/2018] [Accepted: 10/11/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Universal skin and nasal decolonisation reduces multidrug-resistant pathogens and bloodstream infections in intensive care units. The effect of universal decolonisation on pathogens and infections in non-critical-care units is unknown. The aim of the ABATE Infection trial was to evaluate the use of chlorhexidine bathing in non-critical-care units, with an intervention similar to one that was found to reduce multidrug-resistant organisms and bacteraemia in intensive care units. METHODS The ABATE Infection (active bathing to eliminate infection) trial was a cluster-randomised trial of 53 hospitals comparing routine bathing to decolonisation with universal chlorhexidine and targeted nasal mupirocin in non-critical-care units. The trial was done in hospitals affiliated with HCA Healthcare and consisted of a 12-month baseline period from March 1, 2013, to Feb 28, 2014, a 2-month phase-in period from April 1, 2014, to May 31, 2014, and a 21-month intervention period from June 1, 2014, to Feb 29, 2016. Hospitals were randomised and their participating non-critical-care units assigned to either routine care or daily chlorhexidine bathing for all patients plus mupirocin for known methicillin-resistant Staphylococcus aureus (MRSA) carriers. The primary outcome was MRSA or vancomycin-resistant enterococcus clinical cultures attributed to participating units, measured in the unadjusted, intention-to-treat population as the HR for the intervention period versus the baseline period in the decolonisation group versus the HR in the routine care group. Proportional hazards models assessed differences in outcome reductions across groups, accounting for clustering within hospitals. This trial is registered with ClinicalTrials.gov, number NCT02063867. FINDINGS There were 189 081 patients in the baseline period and 339 902 patients (156 889 patients in the routine care group and 183 013 patients in the decolonisation group) in the intervention period across 194 non-critical-care units in 53 hospitals. For the primary outcome of unit-attributable MRSA-positive or VRE-positive clinical cultures (figure 2), the HR for the intervention period versus the baseline period was 0·79 (0·73-0·87) in the decolonisation group versus 0·87 (95% CI 0·79-0·95) in the routine care group. No difference was seen in the relative HRs (p=0·17). There were 25 (<1%) adverse events, all involving chlorhexidine, among 183 013 patients in units assigned to chlorhexidine, and none were reported for mupirocin. INTERPRETATION Decolonisation with universal chlorhexidine bathing and targeted mupirocin for MRSA carriers did not significantly reduce multidrug-resistant organisms in non-critical-care patients. FUNDING National Institutes of Health.
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Affiliation(s)
- Susan S Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA.
| | - Edward Septimus
- Clinical Services Group, HCA Healthcare, Houston, TX, USA; Division of Infectious Diseases, Texas A&M College of Medicine, Houston, TX, USA; Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | | | | | - Lauren Heim
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Adrijana Gombosev
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Taliser R Avery
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Katherine Haffenreffer
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Lauren Shimelman
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Mary K Hayden
- Division of Infectious Diseases, Rush Medical College, Chicago, IL, USA
| | - Robert A Weinstein
- Division of Infectious Diseases, Rush Medical College, Chicago, IL, USA; Department of Medicine, Cook County Health and Hospitals System, Chicago, IL, USA
| | | | - Rebecca E Kaganov
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Michael V Murphy
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | | | - Julie Lankiewicz
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Micaela H Coady
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
| | - Lena Portillo
- Division of Infectious Diseases, Rush Medical College, Chicago, IL, USA
| | - Jalpa Sarup-Patel
- Division of Infectious Diseases, Rush Medical College, Chicago, IL, USA
| | - John A Jernigan
- Office of HAI Prevention Research and Evaluation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Richard Platt
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
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10
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Caya T, Knobloch MJ, Musuuza J, Wilhelmson E, Safdar N. Patient perceptions of chlorhexidine bathing: A pilot study using the health belief model. Am J Infect Control 2019; 47:18-22. [PMID: 30174255 DOI: 10.1016/j.ajic.2018.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/06/2018] [Accepted: 07/08/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many studies investigating daily chlorhexidine gluconate (CHG) bathing as an infection control intervention to decrease health care-associated infections have focused on reduction of infection and colonization; few studies have assessed CHG bathing compliance, work system factors, facilitators, and barriers to implementation. METHODS This is a combination retrospective/prospective pilot study conducted at a large academic teaching hospital that implemented daily CHG bathing across all inpatient units. CHG compliance and patient refusal were calculated on the basis of documentation in the electronic medical record. We used the health belief model to guide semistructured interviews with patients about knowledge and barriers related to CHG bathing. RESULTS Of the 31 patients interviewed, 74% reported using CHG soap during their stay. Average compliance documented in the electronic medical record was 78% with a range of 57%-91% among all hospital units. Sixteen percent of patients declined CHG bathing, and refusal ranged from 3%-29% among all units. Major themes about CHG bathing from patient interviews include low perceived susceptibility to infection, high degree of trust in medical professionals, low knowledge of benefits of CHG, and low perceived self-efficacy in preventing HAIs. CONCLUSIONS Educating patients about CHG bathing appears to be a critical factor in decreasing patient refusal of CHG bathing.
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Affiliation(s)
- Teresa Caya
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mary Jo Knobloch
- William S. Middleton Memorial Veterans Hospital, and the Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jackson Musuuza
- William S. Middleton Memorial Veterans Hospital, and the Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Nasia Safdar
- William S. Middleton Memorial Veterans Hospital, and the Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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11
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Chlorhexidine bathing and Clostridium difficile infection in a surgical intensive care unit. J Surg Res 2018; 228:107-111. [PMID: 29907198 DOI: 10.1016/j.jss.2018.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 02/09/2018] [Accepted: 02/27/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Clostridium difficile is the most common causative pathogen for hospital-acquired infections in the intensive care unit. This study evaluated the effect of chlorhexidine bathing every other day in preventing hospital-acquired C. difficile infection (CDI) using data from the CHlorhexidine Gluconate BATHing (CHG-BATH) randomized trial. METHODS The primary endpoint was the proportion of patients acquiring CDIs among patients at risk for incident CDIs. Infections detected >48 h after randomization were classified as incident CDIs. Infections detected before or within 48 h of randomization were classified as prevalent CDIs. RESULTS Of 38 patients (11.7%) who met criteria for potential CDI and underwent adjudication, 24 (7.4%) received oral or enema vancomycin, 18 (5.5%) had a positive C. difficile molecular assay, 14 (4.3%) received an International Classification of Diseases, Ninth Revision, Clinical Modification code for CDI, and 2 (0.6%) had possible pseudomembranous colitis on histopathology reports. The prevalence of CDI was 3.7% (6 of 164) in the soap and water arm and 4.3% (7 of 161) in the chlorhexidine arm. Compared with daily soap and water bathing, 2% chlorhexidine bathing every other day was not associated with the prevention of hospital-acquired CDI (1.3% [2 of 152] soap and water versus 2.0% [3 of 148] chlorhexidine, P = 0.68). CONCLUSIONS It is inconclusive if there was an association between chlorhexidine bathing and incidence of CDI among surgical intensive care unit patients in this study as statistical power was limited. There are limited published data evaluating the association between chlorhexidine bathing and CDI, and this study provides data for future systematic reviews and meta-analyses.
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12
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Differential Effects of Chlorhexidine Skin Cleansing Methods on Residual Chlorhexidine Skin Concentrations and Bacterial Recovery. Infect Control Hosp Epidemiol 2018; 39:405-411. [PMID: 29493475 DOI: 10.1017/ice.2017.312] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bathing intensive care unit (ICU) patients with 2% chlorhexidine gluconate (CHG)-impregnated cloths decreases the risk of healthcare-associated bacteremia and multidrug-resistant organism transmission. Hospitals employ different methods of CHG bathing, and few studies have evaluated whether those methods yield comparable results. OBJECTIVE To determine whether 3 different CHG skin cleansing methods yield similar residual CHG concentrations and bacterial densities on skin. DESIGN Prospective, randomized 2-center study with blinded assessment. PARTICIPANTS AND SETTING Healthcare personnel in surgical ICUs at 2 tertiary-care teaching hospitals in Chicago, Illinois, and Boston, Massachusetts, from July 2015 to January 2016. INTERVENTION Cleansing skin of one forearm with no-rinse 2% CHG-impregnated polyester cloth (method A) versus 4% CHG liquid cleansing with rinsing on the contralateral arm, applied with either non-antiseptic-impregnated cellulose/polyester cloth (method B) or cotton washcloth dampened with sterile water (method C). RESULTS In total, 63 participants (126 forearms) received method A on 1 forearm (n=63). On the contralateral forearm, 33 participants received method B and 30 participants received method C. Immediately and 6 hours after cleansing, method A yielded the highest residual CHG concentrations (2500 µg/mL and 1250 µg/mL, respectively) and lowest bacterial densities compared to methods B or C (P<.001). CONCLUSION In healthy volunteers, cleansing with 2% CHG-impregnated cloths yielded higher residual CHG concentrations and lower bacterial densities than cleansing with 4% CHG liquid applied with either of 2 different cloth types and followed by rinsing. The relevance of these differences to clinical outcomes remains to be determined. Infect Control Hosp Epidemiol 2018;39:405-411.
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Clostridium Difficile Infection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention. Infect Control Hosp Epidemiol 2018; 38:476-482. [PMID: 28300019 DOI: 10.1017/ice.2016.324] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Prevention of Clostridium difficile infection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009. DESIGN We searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015. SETTING We included studies performed in acute-care hospitals. PATIENTS OR PARTICIPANTS We included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates. INTERVENTIONS We used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible. RESULTS Of 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates. CONCLUSIONS Daily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates. Infect Control Hosp Epidemiol 2017;38:476-482.
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Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial. Crit Care Med 2017; 44:1822-32. [PMID: 27428384 DOI: 10.1097/ccm.0000000000001820] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypothesis that compared with daily soap and water bathing, 2% chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients. DESIGN This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded. SETTING Twenty-four-bed surgical ICU at a quaternary academic medical center. PATIENTS Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included. INTERVENTIONS Patients were randomized to bathing with 2% chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm). MEASUREMENTS AND MAIN RESULTS The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95% CI, 0.309-0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0% (95% CI, 1.5-16.4%; p = 0.019). Incidences of adverse skin occurrences were similar (18.9% soap and water vs 18.6% chlorhexidine; p = 0.95). CONCLUSIONS Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.
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Susceptibility of Nosocomial Staphylococcus aureus to Chlorhexidine After Implementation of a Hospital-wide Antiseptic Bathing Regimen. Infect Control Hosp Epidemiol 2017; 38:873-875. [PMID: 28473008 DOI: 10.1017/ice.2017.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hospital use of chlorhexidine (CHX) containing antiseptics to decrease nosocomial infections may promote CHX resistance among pathogenic organisms. Nosocomial bloodstream-infecting Staphylococcus aureus isolates from before and after adoption of hospital-wide CHX bathing were tested for CHX susceptibility, and no decreased susceptibility or resistance-promoting genes were discovered. Infect Control Hosp Epidemiol 2017;38:873-875.
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Reese SM, Burnet N, Smith J, Escudero H, Knepper BC, Young HL. Hospital-wide chlorhexidine gluconate bed bathing protocol: A cross-sectional study in a single hospital. Am J Infect Control 2017; 45:569-571. [PMID: 28063726 DOI: 10.1016/j.ajic.2016.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022]
Abstract
The objective of this study was to determine understanding of bed bathing practices over time after the implementation of a standardized bed bathing protocol. An online survey addressing bathing practices was administered preintervention and 6 and 18 months postintervention to all nurses and technicians caring for adult patients. Survey responses suggested that the intervention resulted in sustained understanding of the standardized bed bathing protocol.
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Affiliation(s)
- Sara M Reese
- Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO.
| | - Nicole Burnet
- Department of Nursing, Denver Health Medical Center, Denver, CO
| | - Jan Smith
- Department of Nursing, Denver Health Medical Center, Denver, CO
| | | | - Bryan C Knepper
- Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO
| | - Heather L Young
- Department of Patient Safety and Quality, Denver Health Medical Center, Denver, CO
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Reduction in hospital-associated methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus with daily chlorhexidine gluconate bathing for medical inpatients. Am J Infect Control 2017; 45:255-259. [PMID: 27938986 DOI: 10.1016/j.ajic.2016.09.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/03/2016] [Accepted: 09/06/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Daily bathing with chlorhexidine gluconate (CHG) is increasingly used in intensive care units to prevent hospital-associated infections, but limited evidence exists for noncritical care settings. METHODS A prospective crossover study was conducted on 4 medical inpatient units in an urban, academic Canadian hospital from May 1, 2014-August 10, 2015. Intervention units used CHG over a 7-month period, including a 1-month wash-in phase, while control units used nonmedicated soap and water bathing. Rates of hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization or infection were the primary end point. Hospital-associated S. aureus were investigated for CHG resistance with a qacA/B and smr polymerase chain reaction (PCR) and agar dilution. RESULTS Compliance with daily CHG bathing was 58%. Hospital-associated MRSA and VRE was decreased by 55% (5.1 vs 11.4 cases per 10,000 inpatient days, P = .04) and 36% (23.2 vs 36.0 cases per 10,000 inpatient days, P = .03), respectively, compared with control cohorts. There was no significant difference in rates of hospital-associated Clostridium difficile. Chlorhexidine resistance testing identified 1 isolate with an elevated minimum inhibitory concentration (8 µg/mL), but it was PCR negative. CONCLUSIONS This prospective pragmatic study to assess daily bathing for CHG on inpatient medical units was effective in reducing hospital-associated MRSA and VRE. A critical component of CHG bathing on medical units is sustained and appropriate application, which can be a challenge to accurately assess and needs to be considered before systematic implementation.
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Partnering to Improve Outcomes: The Nurse Executive and the Clinical Nurse Specialist. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.mnl.2016.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Musuuza JS, Safdar N. Every other day bathing with chlorhexidine gluconate: what is the evidence? ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:506. [PMID: 28149868 DOI: 10.21037/atm.2016.11.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jackson S Musuuza
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; ; Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA; ; Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Abstract
Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent for S. aureus nasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well as Candida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.
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Standardizing Direct Observation for Assessing Compliance to a Daily Chlorhexidine Bathing Protocol Among Hospitalized Patients. Infect Control Hosp Epidemiol 2016; 37:1516-1518. [PMID: 27677927 DOI: 10.1017/ice.2016.214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
BACKGROUND Health-care-associated infections (HAIs), infections that patients contract during the course of their hospitalization, are receiving a growing amount of attention. Heavy skin bacterial colonization aids in the transmission and development of HAIs. Nurses frequently use bathing with chlorhexidine gluconate (CHG) to reduce patients' cutaneous microbial burden. This intervention has been shown to have promising but mixed results in the prevention of HAIs. PURPOSE This article reviews the literature for evidence on the impact of CHG bathing on HAIs. METHOD A literature search was conducted to identify peer-reviewed studies and meta-analyses that examined the impact of CHG bathing on HAIs using PubMed and CINAHL with the following search terms: CHG bathing AND healthcare associated infections, surgical site infections ( SSIs), central line associated bloodstream infections ( CLABSIs), ventilator-associated pneumonias ( VAP), catheter-associated urinary-tract infections ( CAUTIs), and Clostridium difficile-associated disease. The initial search identified 23 articles for review. Additional studies were identified by searching references used in original studies or review articles on this topic. PRINCIPLE FINDINGS There is good evidence to support incorporating a CHG bathing regimen to reduce the incidence of CLABSIs, SSIs, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) HAIs. CONCLUSION As CHG becomes a standard practice to prevent HAIs, it is important to monitor for adverse reactions and evidence of resistance/susceptibility.
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Affiliation(s)
- Janette Denny
- 1 University of South Florida, St. Petersburg, FL, USA
| | - Cindy L Munro
- 1 University of South Florida, St. Petersburg, FL, USA
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Using a Systems Engineering Initiative for Patient Safety to Evaluate a Hospital-wide Daily Chlorhexidine Bathing Intervention. J Nurs Care Qual 2016; 30:337-44. [PMID: 26035708 DOI: 10.1097/ncq.0000000000000129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We undertook a systems engineering approach to evaluate housewide implementation of daily chlorhexidine bathing. We performed direct observations of the bathing process and conducted provider and patient surveys. The main outcome was compliance with bathing using a checklist. Fifty-seven percent of baths had full compliance with the chlorhexidine bathing protocol. Additional time was the main barrier. Institutions undertaking daily chlorhexidine bathing should perform a rigorous assessment of implementation to optimize the benefits of this intervention.
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Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S108-32. [DOI: 10.1017/s0899823x00193882] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistantStaphylococcus aureus(MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature. Am J Infect Control 2016; 44:e17-21. [PMID: 27131130 DOI: 10.1016/j.ajic.2016.02.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/25/2016] [Indexed: 12/17/2022]
Abstract
Chlorhexidine bathing is effective in reducing levels of pathogens on skin. In this review, we examine the evidence that chlorhexidine bathing can prevent colonization and infection with health care-associated pathogens and reduce dissemination to the environment and the hands of personnel. The importance of education and monitoring of compliance with bathing procedures is emphasized in order to optimize chlorhexidine bathing in clinical practice.
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Petlin A, Schallom M, Prentice D, Sona C, Mantia P, McMullen K, Landholt C. Chlorhexidine gluconate bathing to reduce methicillin-resistant Staphylococcus aureus acquisition. Crit Care Nurse 2016; 34:17-25; quiz 26. [PMID: 25274761 DOI: 10.4037/ccn2014943] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism causing substantial morbidity and mortality in intensive care units. Chlorhexidine gluconate, a topical antiseptic solution, is effective against a wide spectrum of gram-positive and gram-negative bacteria, including MRSA. Objectives To examine the impact of a bathing protocol using chlorhexidine gluconate and bath basin management on MRSA acquisition in 5 adult intensive care units and to examine the cost differences between chlorhexidine bathing by using the bath-basin method versus using prepackaged chlorhexidine-impregnated washcloths. METHODS The protocol used a 4-oz bottle of 4% chlorhexidine gluconate soap in a bath basin of warm water. Patients in 3 intensive care units underwent active surveillance for MRSA acquisition; patients in 2 other units were monitored for a new positive culture for MRSA at any site 48 hours after admission. RESULTS Before the protocol, 132 patients acquired MRSA in 34333 patient days (rate ratio, 3.84). Afterwards, 109 patients acquired MRSA in 41376 patient days (rate ratio, 2.63). The rate ratio difference is 1.46 (95% CI, 1.12-1.90; P = .003). The chlorhexidine soap and bath basin method cost $3.18 as compared with $5.52 for chlorhexidine-impregnated wipes (74% higher). CONCLUSIONS The chlorhexidine bathing protocol is easy to implement, cost-effective, and led to decreased unit-acquired MRSA rates in a variety of adult intensive care units.
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Affiliation(s)
- Ann Petlin
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.
| | - Marilyn Schallom
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Donna Prentice
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Carrie Sona
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Paula Mantia
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Kathleen McMullen
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Cassandra Landholt
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
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Lau CS, Chamberlain RS. Probiotics are effective at preventing Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Int J Gen Med 2016; 9:27-37. [PMID: 26955289 PMCID: PMC4769010 DOI: 10.2147/ijgm.s98280] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea. CDI has increased in incidence and severity over the past decade, and is a growing worldwide health problem associated with substantial health care costs and significant morbidity and mortality. This meta-analysis examines the impact of probiotics on the incidence of Clostridium difficile-associated diarrhea (CDAD) among children and adults, in both hospital and outpatient settings. METHODS A comprehensive literature search of all published randomized control trials (RCTs) assessing the use of probiotics in the prevention of CDAD in patients receiving antibiotic therapy was conducted, and the incidence of CDAD was analyzed. RESULTS Twenty-six RCTs involving 7,957 patients were analyzed. Probiotic use significantly reduced the risk of developing CDAD by 60.5% (relative risk [RR] =0.395; 95% confidence interval [CI], 0.294-0.531; P<0.001). Probiotics proved beneficial in both adults and children (59.5% and 65.9% reduction), especially among hospitalized patients. Lactobacillus, Saccharomyces, and a mixture of probiotics were all beneficial in reducing the risk of developing CDAD (63.7%, 58.5%, and 58.2% reduction). CONCLUSION Probiotic supplementation is associated with a significant reduction in the risk of developing CDAD in patients receiving antibiotics. Additional studies are required to determine the optimal dose and strain of probiotic.
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Affiliation(s)
- Christine Sm Lau
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies
| | - Ronald S Chamberlain
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies; Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA
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Kneflin N, O'Quinn L, Geigle G, Mott B, Nebrig D, Munafo J. Direct care nurses on the shared governance journey towards positive patient outcomes. J Clin Nurs 2016; 25:875-82. [PMID: 26833824 DOI: 10.1111/jocn.13114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To describe shared governance in action through the example of one paediatric institution's decision to institute daily chlorhexidine bathing. BACKGROUND Shared governance processes are discussed extensively in the literature; however, implementation of the processes can be challenging. Recently nurses at one paediatric hospital were involved in a hospital-wide practice change where the theoretical approach of shared governance was actualised. Several questions arose from direct care nurses about unwarranted variations in bathing practices across settings and whether bathing standardisation could address the recent increase in central line-associated bloodstream infections. Shared governance council members identified daily chlorhexidine bathing as a potential intervention to standardise bathing across the hospital and to decrease infection rates. At this time, chlorhexidine bathing had been widely adopted in adult hospitals but was less commonly practiced in paediatric institutions. DESIGN This is a position paper describing the use of shared governance to make a house-wide practice decision and positively impact patient outcomes. METHOD Inquiry Council members conducted a systematic evidence search on best practices around chlorhexidine bathing. This evidence was used in Practice Council discussions to standardise house-wide practice. Once consensus was achieved, council members collaborated with Education Council to ensure understanding, competency, and the adoption and sustainment of the practice change. CONCLUSIONS Patients with central lines are at decreased risk for acquiring a central line-associated blood stream infection due, in part, to the change in nursing practice to include daily chlorhexidine bathing. The shared governance structure was the vehicle through which this practice was vetted and instituted. RELEVANCE TO CLINICAL PRACTICE This paper provides a real-life example of leveraging shared governance structures and the direct care nurse leaders within the councils when an organisation faces critical needs in patient care.
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Affiliation(s)
- Nicole Kneflin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lucy O'Quinn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gina Geigle
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brenda Mott
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Dawn Nebrig
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Munafo
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Rupp ME. Do chlorhexidine patient baths prevent catheter-associated urinary tract infections? THE LANCET. INFECTIOUS DISEASES 2015; 16:8-9. [PMID: 26631834 DOI: 10.1016/s1473-3099(15)00244-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/29/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Mark E Rupp
- Division of Infectious Diseases, University of Nebraska Medical Center, Nebraska Medical Center, Omaha, NE 68198-5400, USA.
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Khanafer N, Voirin N, Barbut F, Kuijper E, Vanhems P. Hospital management of Clostridium difficile infection: a review of the literature. J Hosp Infect 2015; 90:91-101. [DOI: 10.1016/j.jhin.2015.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 02/17/2015] [Indexed: 12/11/2022]
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Chlorhexidine Bathing of Hospitalized Patients: Beliefs and Practices of Nurses and Patient Care Technicians, and Potential Barriers to Compliance. Infect Control Hosp Epidemiol 2015; 36:993-4. [PMID: 25899653 DOI: 10.1017/ice.2015.92] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Induced sporicidal activity of chlorhexidine against Clostridium difficile spores under altered physical and chemical conditions. PLoS One 2015; 10:e0123809. [PMID: 25861057 PMCID: PMC4393272 DOI: 10.1371/journal.pone.0123809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 03/07/2015] [Indexed: 12/31/2022] Open
Abstract
Background Chlorhexidine is a broad-spectrum antimicrobial commonly used to disinfect the skin of patients to reduce the risk of healthcare-associated infections. Because chlorhexidine is not sporicidal, it is not anticipated that it would have an impact on skin contamination with Clostridium difficile, the most important cause of healthcare-associated diarrhea. However, although chlorhexidine is not sporicidal as it is used in healthcare settings, it has been reported to kill spores of Bacillus species under altered physical and chemical conditions that disrupt the spore’s protective barriers (e.g., heat, ultrasonication, alcohol, or elevated pH). Here, we tested the hypothesis that similarly altered physical and chemical conditions result in enhanced sporicidal activity of chlorhexidine against C. difficile spores. Principal Findings C. difficile spores became susceptible to heat killing at 80°C within 15 minutes in the presence of chlorhexidine, as opposed to spores suspended in water which remained viable. The extent to which the spores were reduced was directly proportional to the concentration of chlorhexidine in solution, with no viable spores recovered after 15 minutes of incubation in 0.04%–0.0004% w/v chlorhexidine solutions at 80°C. Reduction of spores exposed to 4% w/v chlorhexidine solutions at moderate temperatures (37°C and 55°C) was enhanced by the presence of 70% ethanol. However, complete elimination of spores was not achieved until 3 hours of incubation at 55°C. Elevating the pH to ≥9.5 significantly enhanced the killing of spores in either aqueous or alcoholic chlorhexidine solutions. Conclusions Physical and chemical conditions that alter the protective barriers of C. difficile spores convey sporicidal activity to chlorhexidine. Further studies are necessary to identify additional agents that may allow chlorhexidine to reach its target within the spore.
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Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, Aureden K, Huang SS, Maragakis LL, Yokoe DS. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35:772-96. [PMID: 24915205 DOI: 10.1086/676534] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Noto MJ, Domenico HJ, Byrne DW, Talbot T, Rice TW, Bernard GR, Wheeler AP. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA 2015; 313:369-78. [PMID: 25602496 PMCID: PMC4383133 DOI: 10.1001/jama.2014.18400] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Daily bathing of critically ill patients with the broad-spectrum, topical antimicrobial agent chlorhexidine is widely performed and may reduce health care-associated infections. OBJECTIVE To determine if daily bathing of critically ill patients with chlorhexidine decreases the incidence of health care-associated infections. DESIGN, SETTING, AND PARTICIPANTS A pragmatic cluster randomized, crossover study of 9340 patients admitted to 5 adult intensive care units of a tertiary medical center in Nashville, Tennessee, from July 2012 through July 2013. INTERVENTIONS Units performed once-daily bathing of all patients with disposable cloths impregnated with 2% chlorhexidine or nonantimicrobial cloths as a control. Bathing treatments were performed for a 10-week period followed by a 2-week washout period during which patients were bathed with nonantimicrobial disposable cloths, before crossover to the alternate bathing treatment for 10 weeks. Each unit crossed over between bathing assignments 3 times during the study. MAIN OUTCOMES AND MEASURES The primary prespecified outcome was a composite of central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonia (VAP), and Clostridium difficile infections. Secondary outcomes included rates of clinical cultures that tested positive for multidrug-resistant organisms, blood culture contamination, health care-associated bloodstream infections, and rates of the primary outcome by ICU. RESULTS During the chlorhexidine bathing period, 55 infections occurred: 4 CLABSI, 21 CAUTI, 17 VAP, and 13 C difficile. During the control bathing period, 60 infections occurred: 4 CLABSI, 32 CAUTI, 8 VAP, and 16 C difficile. The primary outcome rate was 2.86 per 1000 patient-days during the chlorhexidine and 2.90 per 1000 patient-days during the control bathing periods (rate difference, -0.04; 95% CI, -1.10 to 1.01; P = .95). After adjusting for baseline variables, no difference between groups in the rate of the primary outcome was detected. Chlorhexidine bathing did not change rates of infection-related secondary outcomes including hospital-acquired bloodstream infections, blood culture contamination, or clinical cultures yielding multidrug-resistant organisms. In a prespecified subgroup analysis, no difference in the primary outcome was detected in any individual intensive care unit. CONCLUSION AND RELEVANCE In this pragmatic trial, daily bathing with chlorhexidine did not reduce the incidence of health care-associated infections including CLABSIs, CAUTIs, VAP, or C difficile. These findings do not support daily bathing of critically ill patients with chlorhexidine. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02033187.
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Affiliation(s)
- Michael J. Noto
- Departments of Medicine, Vanderbilt University, Nashville TN
| | | | | | - Tom Talbot
- Departments of Medicine, Vanderbilt University, Nashville TN
| | - Todd W. Rice
- Departments of Medicine, Vanderbilt University, Nashville TN
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Abstract
Although originally described in Staphylococcus aureus, resistance among bacteria has now become a race to determine which classes of bacteria will become more resistant. Availability of antibacterial agents has allowed the development of entirely new diseases caused by nonbacterial pathogens, related largely to fungi that are inherently resistant to antibacterials. This article presents the growing body of knowledge of the herpes family of viruses, and their occurrence and consequences in patients with concomitant surgical disease or critical illness. The focus is on previously immunocompetent patients, as the impact of herpes viruses in immunosuppressed patients has received thorough coverage elsewhere.
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Affiliation(s)
- Christopher A Guidry
- Division of Acute Care Surgery and Outcomes Research, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Sara A Mansfield
- Division of Trauma, Critical Care, and Burn, Department of Surgery, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | - Robert G Sawyer
- Division of Acute Care Surgery and Outcomes Research, Department of Surgery, University of Virginia, Charlottesville, VA 22908, USA
| | - Charles H Cook
- Division of Acute Care Surgery, Trauma and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Lowry 2G, Boston, MA 02215, USA.
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Seyman D, Oztoprak N, Berk H, Kizilates F, Emek M. Weekly chlorhexidine douche: does it reduce healthcare-associated bloodstream infections? ACTA ACUST UNITED AC 2014; 46:697-703. [PMID: 25134645 DOI: 10.3109/00365548.2014.931597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Daily chlorhexidine (CHG) bathing has been used as a precaution to reduce the rate of healthcare-associated bloodstream infections (HA-BSI). The application frequency of CHG bathing remains unclear, this procedure has been implemented daily by this time. The aim of this study was to determine the efficacy of weekly whole-body douche with CHG shower gel on rates of HA-BSI. METHODS We conducted a prospective intervention trial in medical, surgical, and anesthesiology intensive care units (ICUs) in a tertiary teaching hospital from June 2011 to November 2012. This study included three periods. During the first period, patients received a daily bed bath by wiping with water and soap. In the second period patients were given a weekly douche with water and soap; in the third period patients were given a weekly douche with CHG shower gel. The rates of HA-BSI were compared between the three periods using Poisson regression analysis. RESULTS The central line-associated bloodstream infection rates did not decline significantly between periods (p = 0.76). The laboratory-confirmed bloodstream infection (LCBSI) rates in the first, second, and third periods were 7.1, 4, and 1.7, respectively. The LCBSI rates were reduced 43.7% from the first period to the second period (p = 0.03). In addition, there was a 57.5% reduction in LCBSI rates between the second and third periods (p < 0.001). Interestingly, the major decline (76.1%) was determined from the first to the third period (p < 0.002). CONCLUSIONS Weekly douche with CHG shower gel significantly reduced LCBSI rates. Further studies are needed to validate the clinical impact of different intervals of CHG bathing.
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Affiliation(s)
- Derya Seyman
- Antalya Education and Research Hospital, Department of Infectious Diseases and Clinical Microbiology
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Armellino D, Woltmann J, Parmentier D, Musa N, Eichorn A, Silverman R, Hirschwerk D, Farber B. Modifying the risk: once-a-day bathing "at risk" patients in the intensive care unit with chlorhexidine gluconate. Am J Infect Control 2014; 42:571-3. [PMID: 24773800 DOI: 10.1016/j.ajic.2013.12.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 12/21/2013] [Accepted: 12/30/2013] [Indexed: 11/16/2022]
Abstract
Chlorhexidine gluconate (CHG) decreases hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) that can cause colonization and infection. A standard approach is the bathing of all patients with CHG to prevent MRSA transmission. To decrease CHG utilization, this study assessed selective daily administration of CHG bathing to intensive care unit patients who had an MRSA-positive result or a central venous catheter. This risk-based approach was associated with a 72% decrease in hospital-acquired MRSA transmission rate.
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Affiliation(s)
- Donna Armellino
- Infection Prevention, North Shore-Long Island Jewish Health System, Lake Success, NY.
| | - Jeanine Woltmann
- Infection Prevention and Nursing, Glen Cove Hospital, Glen Cove, NY
| | | | - Nancy Musa
- Infection Prevention, North Shore-Long Island Jewish Health System, Lake Success, NY
| | - Ann Eichorn
- Krasnoff Quality Management Institute, Lake Success, NY
| | - Robert Silverman
- Division of Infectious Disease, North Shore University Hospital, Manhasset, NY
| | - David Hirschwerk
- Division of Infectious Disease, North Shore University Hospital, Manhasset, NY
| | - Bruce Farber
- Division of Infectious Disease, North Shore University Hospital, Manhasset, NY
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Quach C, Milstone AM, Perpête C, Bonenfant M, Moore DL, Perreault T. Chlorhexidine bathing in a tertiary care neonatal intensive care unit: impact on central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2013; 35:158-63. [PMID: 24442078 DOI: 10.1086/674862] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite implementation of recommended best practices, our central line-associated bloodstream infection (CLABSI) rates remained high. Our objective was to describe the impact of chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates. METHODS Infants with a central venous catheter (CVC) admitted to the neonatal intensive care unit from April 2009 to March 2013 were included. Neonates with a birth weight of 1,000 g or less, aged less than 28 days, and those with a birth weight greater than 1,000 g were bathed with mild soap until March 31, 2012 (baseline), and with a 2% CHG-impregnated cloth starting on April 1, 2012 (intervention). Infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with mild soap during the entire period. Neonatal intensive care unit nurses reported adverse events. Adjusted incidence rate ratios (aIRRs), using Poisson regression, were calculated to compare CLABSIs/1,000 CVC-days during the baseline and intervention periods. RESULTS Overall, 790 neonates with CVCs were included in the study. CLABSI rates decreased during the intervention period for CHG-bathed neonates (6.00 vs 1.92/1,000 CVC-days; aIRR, 0.33 [95% confidence interval (CI), 0.15-0.73]) but remained unchanged for neonates with a birth rate of 1,000 g or less and aged less than 28 days who were not eligible for CHG bathing (8.57 vs 8.62/1,000 CVC-days; aIRR, 0.86 [95% CI, 0.17-4.44]). Overall, 195 infants with a birth weight greater than 1,000 g and 24 infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with CHG. There was no reported adverse event. CONCLUSIONS We observed a decrease in CLABSI rates in CHG-bathed neonates in the absence of observed adverse events. CHG bathing should be considered if CLABSI rates remain high, despite the implementation of other recommended measures.
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Affiliation(s)
- Caroline Quach
- Division of Infection Control, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Mermel LA, Jefferson J, Blanchard K, Parenteau S, Mathis B, Chapin K, Machan JT. Reducing Clostridium difficile Incidence, Colectomies, and Mortality in the Hospital Setting: A Successful Multidisciplinary Approach. Jt Comm J Qual Patient Saf 2013; 39:298-305. [DOI: 10.1016/s1553-7250(13)39042-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Myers FE. Targeting MRSA: is it the right infection prevention goal? Nurs Manag (Harrow) 2013; 44:26-33. [PMID: 23670074 DOI: 10.1097/01.numa.0000430402.57959.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Focus on universal infection prevention strategies, instead of targeted approaches, to reduce MRSA and other healthcare-associated infections.
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Rupp ME, Huerta T, Yu S, Cavalieri RJ, Alter R, Fey PD, Lyden E, Van Schooneveld T. Hospital Basins Used to Administer Chlorhexidine Baths Are Unlikely Microbial Reservoirs. Infect Control Hosp Epidemiol 2013; 34:643-5. [DOI: 10.1086/670622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Basins, commonly used to bathe patients who are unable to bathe themselves, frequently become contaminated with potential pathogens and may serve as a source for nosocomial transmission. Chlorhexidine (CHG) has bactericidal activity against a broad spectrum of pathogens and is increasingly used in antiseptic patient baths. The purpose of this study was to ascertain whether basins used to administer CHG bed baths are likely to become contaminated.Bed bath conditions were simulated by mixing 30 mL of a 4% CHG product or soap preparation to 1 L of warm (37°C) tap water in a 6-L plastic basin (Medical Action Industries). Two commercial brands of CHG (Hibiclens, Molnlycke Health Care [hereafter, CHG-A], or Scrub Care, Cardinal Health [hereafter, CHG-B]) and 1 brand of soap (SensiCare SeptiSoft, ConvaTec) were used. Basins were inoculated with 108 colony-forming units (CFUs) of 1 species of bacteria, mixed for 30 seconds, incubated for 20 minutes at room temperature, emptied, and allowed to dry for 1 hour. A 100-cm2 area on the bottom of the basin was sampled for 10 seconds in 2 directions with a cotton swab premoistened with normal saline. Swab tips were placed in 2 mL of trypticase soy broth (Difco) and vortex-mixed for 30 seconds, and the solution was quantitatively cultured on sheep blood agar (Remel). Cultures were incubated at 37°C for 24 hours, and colonies were counted and expressed as CFUs per square centimeter. Tap water with and without a bacterial inoculum served as positive and negative controls, respectively.
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