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Peixoto EAC, Poveda VDB, Gnatta JR, Oliveira RA. Bathing with wipes impregnated with chlorhexidine gluconate to prevent central line-associated bloodstream infection in critically ill patients: A systematic review with meta-analysis. Am J Infect Control 2024; 52:731-738. [PMID: 38342345 DOI: 10.1016/j.ajic.2024.01.019] [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: 11/26/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Recommendations for different types of bathing to prevent central line-associated bloodstream infections (CLABSI) are still divergent. The objective of this study was to verify whether bed bathing with wipes impregnated with 2% chlorhexidine (CHG) compared to conventional bed bathing is more effective in preventing CLABSI. METHODS Systematic review of the literature by consulting the electronic databases PubMed/Medline, Embase, CINAHL, Scopus, and Web of Science from the date of inception until July 1, 2023, with no language or time restrictions. RESULTS A total of 84,462 studies were examined, of which 6 were included in the meta-analysis. Data from 20,188 critical care patients included in primary studies were analyzed. The meta-analysis found that bed bathing with wipes impregnated with 2% CHG reduced the risk of CLABSI by 48% compared to conventional bed bathing (risk ratio 0.52; 95% confidence interval, 0.37-0.73), and this is moderate-quality evidence. The reduction in length of stay in the intensive care unit and length of hospital stay as well as the risk of death were not significantly different between the study groups. Whether bed bathing with 2% CHG-impregnated wipes increases the occurrence of skin reactions is unclear. CONCLUSIONS This meta-analysis provides moderate-quality evidence that daily bathing with 2% CHG-impregnated wipes is safe and helps prevent CLABSI among adult intensive care unit patients.
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Affiliation(s)
- Erica Almeida Carvalho Peixoto
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Programa de Mestrado Profissional em Enfermagem, R. Comendador Elias Jafet, São Paulo, SP, Brazil.
| | - Vanessa de Brito Poveda
- Departamento de Enfermagem-Médico Cirúrgica, Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.
| | - Juliana Rizzo Gnatta
- Departamento de Enfermagem-Médico Cirúrgica, Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.
| | - Ramon Antonio Oliveira
- Departamento de Enfermagem-Médico Cirúrgica, Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.
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Tchouambou Youmbi C, Gilman TJ, Ndzana Siani IC, Olaye IE, Popoola AF, Yahya SA, Kyeremanteng K, Gandotra S, Casey JD, Semler MW, Mbuagbaw L, Khalifa A, Rochwerg B. Black representation in critical care randomized controlled trials: a meta-epidemiological study. Can J Anaesth 2023; 70:1064-1074. [PMID: 37173564 PMCID: PMC10180607 DOI: 10.1007/s12630-023-02462-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/22/2022] [Accepted: 10/03/2022] [Indexed: 05/15/2023] Open
Abstract
PURPOSE The under-representation of Black people within critical care research limits the generalizability of randomized controlled trials (RCTs). This meta-epidemiologic study investigated the proportionate representation of Black people enrolled at USA and Canadian study sites from high impact critical care RCTs. SOURCE We searched for critical care RCTs published in general medicine and intensive care unit (ICU) journals between 1 January 2016 and 31 December 2020. We included RCTs that enrolled critically ill adults at USA or Canadian sites and provided race-based demographic data by study site. We compared study-based racial demographics with site-level city-based demographics and pooled representation of Black people across studies, cities, and centres using a random effects model. We used meta-regression to explore the impact of the following variables on Black representation in critical care RCTs: country, drug intervention, consent model, number of centres, funding, study site city, and year of publication. PRINCIPAL FINDINGS We included 21 eligible RCTs. Of these, 17 enrolled at only USA sites, two at only Canadian sites, and two at both USA and Canadian sites. Black people were under-represented in critical care RCTs by 6% compared with population-based city demographics (95% confidence interval, 1 to 11). Using meta-regression, after controlling for pertinent variables, the country of the study site was the only significant source of heterogeneity (P = 0.02). CONCLUSION Black people are under-represented in critical care RCTs compared with site-level city-based demographics. Interventions are required to ensure adequate Black representation in critical care RCTs at both USA and Canadian study sites. Further research is needed to investigate the factors contributing to Black under-representation in critical care RCTs.
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Affiliation(s)
- Cheikh Tchouambou Youmbi
- McMaster Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tyler Jordan Gilman
- McMaster Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
| | | | - Ida-Ehosa Olaye
- Department of Kinesiology, McMaster University, Hamilton, ON Canada
| | | | | | | | - Sheetal Gandotra
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama Birmingham, Birmingham, AL USA
| | - Jonathan Dale Casey
- Department of Medicine, Vanderbilt University, Nashville, TN USA
- Pragmatic Critical Care Research Group, Vanderbilt University, Nashville, TN USA
| | - Matthew Wall Semler
- Department of Medicine, Vanderbilt University, Nashville, TN USA
- Pragmatic Critical Care Research Group, Vanderbilt University, Nashville, TN USA
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON Canada
| | - Abubaker Khalifa
- Department of Medicine (Critical Care), Juravinski Hospital, McMaster University, Hamilton, ON Canada
| | - Bram Rochwerg
- Department of Medicine (Critical Care), Juravinski Hospital, McMaster University, Hamilton, ON Canada
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Klompas M, Branson R, Cawcutt K, Crist M, Eichenwald EC, Greene LR, Lee G, Maragakis LL, Powell K, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 43:687-713. [PMID: 35589091 PMCID: PMC10903147 DOI: 10.1017/ice.2022.88] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Richard Branson
- Department of Surgery, University of Cincinnati Medicine, Cincinnati, Ohio
| | - Kelly Cawcutt
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Matthew Crist
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric C Eichenwald
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Linda R Greene
- Highland Hospital, University of Rochester, Rochester, New York
| | - Grace Lee
- Stanford University School of Medicine, Palo Alto, California
| | - Lisa L Maragakis
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Krista Powell
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gregory P Priebe
- Department of Anesthesiology, Critical Care and Pain Medicine; Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Kathleen Speck
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Deborah S Yokoe
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Sean M Berenholtz
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Manerikar A, Watanabe S, Kandula V, Karim A, Thakkar S, Saine M, Kim SS, Garza-Castillon R, Odell DD, Bharat A, Kurihara C. Indwelling Central Venous Catheters Drive Bloodstream Infection During Veno-venous Extracorporeal Membrane Oxygenation Support. ASAIO J 2022; 68:859-864. [PMID: 34593682 PMCID: PMC8958168 DOI: 10.1097/mat.0000000000001575] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Blood stream infection (BSI) is a potentially lethal complication in patients receiving extracorporeal membrane oxygenation (ECMO). It may be particularly common in patients with veno-venous ECMO due to their long hospitalization in the intensive care unit. Given that these patients have concurrent indwelling central venous catheters (CVC), it is unclear whether the ECMO circuit, CVC, or both, contribute to BSI. This study evaluated the risk factors associated with BSI in patients receiving veno-venous ECMO in a single institution study of 61 patients from 2016 through 2019. All ECMO catheters and the circuit oxygenator fluid were aseptically collected and analyzed for microorganisms at the time of decannulation. New BSI was diagnosed in 15 (24.6%) patients and increased mortality by threefold. None of the ECMO catheters or oxygenator fluid were culture positive. BSI increased with CVC use of over 8 days and was significantly lowered when CVC were exchanged by day 8 compared with patients with exchanges at later points (15.0% vs. 42.8%, p = 0.02). Median length of CVC use in the BSI-negative and BSI-positive group were 6.3 ± 5.0 and 9.4 ± 5.1, respectively (p = 0.04). In summary, BSI is a potentially lethal complication in patients receiving ECMO. Indwelling CVC, not the ECMO circuitry, is the likely contributor for BSI, and exchanging CVC by day 8 can reduce the incidence of BSI.
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Affiliation(s)
- Adwaiy Manerikar
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Satoshi Watanabe
- Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Viswajit Kandula
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Azad Karim
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Sanket Thakkar
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Mark Saine
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Samuel S. Kim
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Rafael Garza-Castillon
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - David D. Odell
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
- Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
| | - Chitaru Kurihara
- Department of Surgery, Northwestern University Feinberg School of Medicine, 676 N. St Clair St, Suite 650, Chicago, Illinois 60611
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M. Patil S. Hospital-Acquired Pneumonia. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.101236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Pneumonia acquired during hospitalization is called nosocomial pneumonia (NP). Nosocomial pneumonia is divided into two types. Hospital-acquired pneumonia (HAP) refers to hospital-acquired pneumonia, whereas ventilator-associated pneumonia (VAP) refers to ventilator-associated pneumonia. Most clinical literature stresses VAP’s importance and associated mortality and morbidity, whereas HAP is not given enough attention even while being the most common cause of NP. HAP, like VAP, carries a high mortality and morbidity. HAP is the commonest cause of mortality from hospital-acquired infections. HAP is a common determinant for intensive care unit (ICU) admits with respiratory failure. Recent research has identified definite risk factors responsible for HAP. If these are prevented or modified, the HAP incidence can be significantly decreased with improved clinical outcomes and lesser utilization of the health care resources. The prevention approach will need multiple strategies to address the issues. Precise epidemiological data on HAP is deficient due to limitations of the commonly used diagnostic measures. The diagnostic modalities available in HAP are less invasive than VAP. Recent infectious disease society guidelines have stressed the importance of HAP by removing healthcare-associated pneumonia as a diagnosis. Specific differences exist between HAP and VAP, which are gleaned over in this chapter.
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Synthesis, Drug Release, and Antibacterial Properties of Novel Dendritic CHX-SrCl 2 and CHX-ZnCl 2 Particles. Pharmaceutics 2021; 13:pharmaceutics13111799. [PMID: 34834214 PMCID: PMC8625704 DOI: 10.3390/pharmaceutics13111799] [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: 09/17/2021] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 12/29/2022] Open
Abstract
This work demonstrated for the first time the synthesis of novel chlorhexidine particles containing strontium and zinc, to provide an effective, affordable, and safe intervention in the treatment of recurrent infections found in Medicine and Dentistry. The CHX-SrCl2 and CHX-ZnCl2 particles were synthesized by co-precipitation of chlorhexidine diacetate (CHXD) and zinc chloride or strontium chloride, where particle size was manipulated by controlling processing time and temperature. The CHX-ZnCl2 and CHX-SrCl2 particles were characterized using SEM, FTIR, and XRD. UV-Vis using artificial saliva (pH 4 and pH 7) was used to measure the drug release and ICP-OES ion release. The antibacterial properties were examined against P. gingivalis, A. actinomycetemcomitans, and F. nucleatum subsp. Polymorphum, and cytotoxicity was evaluated using mouse fibroblast L929 cells. The novel particles were as safe as commercial CHXD, with antibacterial activity against a range of oral pathogens. UV-Vis results run in artificial saliva (pH 4 and pH 7) indicated a higher release rate in acidic rather than neutral conditions. The CHX-ZnCl2 particles provided the functionality of a smart Zinc and CHX release, with respect to environmental pH, allowing responsive antibacterial applications in the field of medicine and dentistry.
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Zerr DM, Milstone AM, Dvorak CC, Adler AL, Chen L, Villaluna D, Dang H, Qin X, Addetia A, Yu LC, Conway Keller M, Esbenshade AJ, August KJ, Fisher BT, Sung L. Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double-blinded randomized controlled trial from the Children's Oncology Group. Cancer 2021; 127:56-66. [PMID: 33079403 PMCID: PMC7820990 DOI: 10.1002/cncr.33271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND To the authors' knowledge, information regarding whether daily bathing with chlorhexidine gluconate (CHG) reduces central line-associated bloodstream infection (CLABSI) in pediatric oncology patients and those undergoing hematopoietic stem cell transplantation (HCT) is limited. METHODS In the current multicenter, randomized, double-blind, placebo-controlled trial, patients aged ≥2 months and <22 years with cancer or those undergoing allogeneic HCT were randomized 1:1 to once-daily bathing with 2% CHG-impregnated cloths or control cloths for 90 days. The primary outcome was CLABSI. Secondary endpoints included total positive blood cultures, acquisition of resistant organisms, and acquisition of cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration. RESULTS The study was stopped early because of poor accrual. Among the 177 enrolled patients, 174 were considered as evaluable (88 were randomized to the CHG group and 86 were randomized to the control group). The rate of CLABSI per 1000 central line days in the CHG group was 5.44 versus 3.10 in the control group (risk difference, 2.37; 95% confidence interval, 0.05-4.69 [P = .049]). Post hoc conditional power analysis demonstrated a 0.2% chance that the results would have favored CHG had the study fully enrolled. The rate of total positive blood cultures did not differ between groups (risk difference, 2.37; 95% confidence interval, -0.41 to 5.14 [P = .078]). The number of patients demonstrating the new acquisition of resistant organisms did not differ between groups (P = .54). Patients in the CHG group were found to be more likely to acquire cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration (P = .032). CONCLUSIONS The data from the current study do not support the use of routine CHG bathing in children with cancer or those undergoing allogeneic HCT.
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Affiliation(s)
- Danielle M. Zerr
- Seattle Children's Research InstituteSeattleWashington,Department of PediatricsUniversity of WashingtonSeattleWashington
| | - Aaron M. Milstone
- Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Christopher C. Dvorak
- Division of Pediatric Allergy, Immunology, and Blood and Marrow TransplantationUniversity of California at San FranciscoSan FranciscoCalifornia
| | | | - Lu Chen
- Division of BiostatisticsCity of HopeDuarteCalifornia
| | | | - Ha Dang
- Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Xuan Qin
- Seattle Children's Research InstituteSeattleWashington
| | - Amin Addetia
- Seattle Children's Research InstituteSeattleWashington
| | - Lolie C. Yu
- Department of PediatricsChildren's HospitalLouisiana State University Health New OrleansNew OrleansLouisiana
| | - Mary Conway Keller
- Division of Hematology/OncologyConnecticut Children's Medical CenterHartfordConnecticut
| | - Adam J. Esbenshade
- Department of Pediatricsthe Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt‐Ingram Cancer Center, Vanderbilt University School of MedicineNashvilleTennessee
| | - Keith J. August
- Department of PediatricsChildren's Mercy HospitalKansas CityMissouri
| | - Brian T. Fisher
- Division of Pediatric Infectious DiseasesChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania,Department of Biostatistics, Epidemiology and InformaticsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Lillian Sung
- Division of Haematology/Oncology, Program in Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoOntarioCanada
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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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Jia Q, Tong XM. [A review on the characteristics of microbiome and their association with diseases in preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:1240-1244. [PMID: 33172562 PMCID: PMC7666391 DOI: 10.7499/j.issn.1008-8830.2005131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/01/2020] [Indexed: 06/11/2023]
Abstract
The microbiome in neonates is affected by many factors such as mode of birth and feeding pattern, and homeostasis or disorder of microbiome is associated with various neonatal diseases. Preterm infants have a gestational age of <37 weeks at birth, with immature development and different colonization of bacteria from full-term infants. The research on the characteristics of microbiome and their association with diseases in preterm infants can provide new ideas for the treatment of neonatal diseases. This article reviews the characteristics of intrauterine microbiome, dermal microbiome, oral microbiome, stomach microbiome, intestinal microbiome, and environmental microbiome and their association with common diseases in preterm infants.
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Affiliation(s)
- Qiong Jia
- Department of Pediatrics, Peking University Third Hospital, Beijing 100191, China.
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10
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Does preventive care bundle have an impact on surgical site infections following spine surgery? An analysis of 9607 patients. Spine Deform 2020; 8:677-684. [PMID: 32162198 DOI: 10.1007/s43390-020-00099-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The purpose was to analyze the effect of care bundle protocol on SSI in our institution. Postoperative surgical site infections (SSI) pose significant health burden. In spite of the use of prophylactic antibiotics, surgical advances and postoperative care, wound infection continues to affect patient outcomes after spine surgery. METHODS Retrospective analysis of 9607 consecutive patients who underwent spine procedures from 2014 to 2018 was performed. Preventive care bundle was implemented from January 2017 consisting of (a) preoperative bundle-glycemic control, chlorhexidine gluconate (CHG) bath, (b) intra-operative bundle-time specified antibiotic prophylaxis, CHG+ alcohol-based skin preparation (c) postoperative bundle-five moments of hand hygiene, early mobilization and bundle auditing. Patients operated from January 2017 were included in the post-implementation cohort and prior to that the pre-implementation cohort was formed. Data were drawn from weekly and yearly spine audits from the hospital infection committee software. Infection data were collected based on CDC criteria, further sub classification was done based on procedure, spinal disorders and spine level. Variables were analyzed and level of significance was set as < 0.05. RESULTS A total of 7333 patients met the criteria. The overall SSI rate decreased from 3.42% (131/3829) in pre-implementation cohort to 1.22% (43/3504, p = 0.0001) in post-implementation cohort (RR = 2.73, OR = 2.79). Statistically significant reduction was seen in all the groups (a) superficial and deep, (b) early and late and (c) instrumented and uninstrumented groups but was more pronounced in early (p = 0.0001), superficial (p = 0.0001) and instrumented groups (p = 0.0001). On subgroup analysis based on spine level and spinal disorders, significant reduction was seen in lumbar (p = 0.0001) and degenerative group (p = 0.0001). CONCLUSIONS Our study revealed significant reduction of SSI secondary to strict bundle adherence and monitored compliance compared to patients who did not receive these interventions. LEVEL OF EVIDENCE III.
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Martinez T, Baugnon T, Vergnaud E, Duracher C, Perie AC, Bustarret O, Jugie M, Rubinsztajn R, Frange P, Meyer P, Orliaguet G, Blanot S. Central-line-associated bloodstream infections in a surgical paediatric intensive care unit: Risk factors and prevention with chlorhexidine bathing. J Paediatr Child Health 2020; 56:936-942. [PMID: 31943493 DOI: 10.1111/jpc.14780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/26/2019] [Accepted: 01/05/2020] [Indexed: 11/30/2022]
Abstract
AIM The aims of the study are to evaluate the impact of a 4% chlorhexidine (CHG4%) bathing on the occurrence of central-line-associated bloodstream infection (CLABSI) and to identify risk factors (RFs) for CLABSI in our population. This is a retrospective monocentric cohort study in the paediatric surgical intensive care unit at the Necker Enfants Malades Hospital, Paris, France. METHODS All hospitalised patients with central venous catheters (CVCs) in 2015 were included. CHG4% bathing was prescribed in CLABSI high-risk patients, defined by the presence of exposition factors (EFs): constitutive or acquired immunosuppression, presence of an invasive medical device (IMD) and the carriage of Staphylococcus aureus. The overall 2015 CLABSI incidence rate was compared with 2014 CLABSI incidence rate (before CHG4% bathing). RESULTS In all, 775 patients were analysed. Some 182 had at least one EF, and 49 received CHG4%. The incidence rates of CLABSI in 2014 and 2015 were, respectively, 6.1 and 2.3/1000 days CVC (P < 0.01). The presence of at least one EF was associated with the CLABSI's occurrence: odds ratio = 15.13 (95% confidence interval: 4.26-53.71; P < 0.0001), particularly acquired immunosuppression, IMD and S. aureus colonisation. Other RFs were age <1 year and carrying duration >16 days. CONCLUSIONS This study showed a significant reduction in incidence of CLABSI after introduction of a targeted CHG4% bathing protocol. Presence of IMD, S. aureus colonisation, immunosuppression, age <1 year and carrying duration >16 days were CLABSI RFs. Regarding the literature, the presence of IMD seems to be underestimated in CLABSI prevention.
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Affiliation(s)
- Thibault Martinez
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Thomas Baugnon
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Estelle Vergnaud
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Caroline Duracher
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Anne C Perie
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Olivier Bustarret
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Myriam Jugie
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Robert Rubinsztajn
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Pierre Frange
- Hospital Infection Control Team, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Philippe Meyer
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Gilles Orliaguet
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
| | - Stéphane Blanot
- Surgical Pediatric Intensive Care Unit, Universitary Hospital Necker Enfants Malades, Paris, France
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Cannula-Related Infection in Patients Supported by Peripheral ECMO: Clinical and Microbiological Characteristics. ASAIO J 2020. [PMID: 29517513 DOI: 10.1097/mat.0000000000000771] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Little is known about cannula-related infection (CRI) in patients supported by extracorporeal membrane oxygenation (ECMO). The aim of this study was to assess the incidence, the risk factors, prognosis, and microbiological characteristics of CRI in patients supported by ECMO. This retrospective cohort study was conducted in one intensive care unit (ICU). Among 220 consecutive patients with peripheral ECMO, 39 (17.7%) developed CRI. The incidence of CRI was 17.2 per 1,000 ECMO days. The main isolated microorganisms were Enterobacteriaceae (38%), Staphylococcus spp. (28.2%; 8.5% were methicillin-sensitive Staphylococcus aureus and 19.7% were coagulase-negative staphylococci), and Pseudomonas aeruginosa (18.3%). Bacteremia was present in 23 cases (59.7%). In multivariate analysis, the risk factors for CRI were longer ECMO duration (p = 0.006) and higher Simplified Acute Physiology Score 2 (p = 0.004). Forty-one percentage of patients with CRI needed surgical management of the infected site. Cannula-related infection was not associated with higher in-hospital mortality (p = 0.73), but it was associated with a longer stay in ICU (p < 0.0001) and a longer stay in hospital (p = 0.002). In conclusion, CRI is frequent in patients with ECMO and associated with a longer stay in hospital. Risk factors for CRI were longer ECMO duration and higher Simplified Acute Physiology Score 2. Concomitant bacteremia was frequent (59.7%) and CRI should be strongly investigated in cases of positive blood culture.
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Bui LN, Swan JT, Perez KK, Johnson ML, Chen H, Colavecchia AC, Rizk E, Graviss EA. Impact of Chlorhexidine Bathing on Antimicrobial Utilization in Surgical Intensive Care Unit. J Surg Res 2020; 250:161-171. [PMID: 32065967 DOI: 10.1016/j.jss.2019.12.049] [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: 07/27/2019] [Revised: 11/05/2019] [Accepted: 12/26/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND This secondary analysis compared antimicrobial utilization among surgical intensive care unit patients randomized to every other day chlorhexidine bathing (chlorhexidine) versus daily soap and water bathing (soap-and-water) using data from the CHlorhexidine Gluconate BATHing trial. MATERIALS AND METHODS Antimicrobial utilization was quantified using defined daily dose (DDD)/100 patient-days and agent-days/100 patient-days for systemic antimicrobials. Antivirals (except oseltamivir), antiparasitics, and prophylaxis agents were excluded. The 2018 anatomic therapeutic chemical/DDD index was used to calculate DDD. Agent-days were calculated as the sum of calendar days where antimicrobials were administered. Patient-days were defined as time patients were at risk for health care-acquired infections plus up to 14 d. Primary analyses were conducted using linear regression adjusted for baseline Acute Physiology and Chronic Health Evaluation II scores. RESULTS Of 325 CHlorhexidine Gluconate BATHing trial patients, 312 (157 in soap-and-water and 155 in chlorhexidine) were included. The median (interquartile range) of total antimicrobial DDD/100 patient-days was 135.4 (75.2-231.8) for soap-and-water and 129.9 (49.2-215.3) for chlorhexidine. The median (interquartile range) of total antimicrobial agent-days/100 patient-days was 155.6 (83.3-243.2) for soap-and-water and 146.7 (66.7-217.4) for chlorhexidine. After adjusting for Acute Physiology and Chronic Health Evaluation II scores, chlorhexidine bathing was associated with a nonsignificant reduction in total antimicrobial DDD/100 patient-days (-3.9; 95% confidence interval, -33.9 to 26.1; P = 0.80) and total antimicrobial agent-days/100 patient-days (-10.3; 95% confidence interval, -34.7 to 14.1; P = 0.41). CONCLUSIONS Compared with daily soap and water bathing, every other day chlorhexidine bathing did not significantly reduce total antimicrobial utilization in surgical intensive care unit patients.
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Affiliation(s)
- Lan N Bui
- Department of Pharmacy Practice, Samford University McWhorter School of Pharmacy, Birmingham, Alabama; Houston Methodist Research Institute, Houston, Texas
| | - Joshua T Swan
- Houston Methodist Research Institute, Houston, Texas; Department of Pharmacy Services, Houston Methodist Hospital, Houston, Texas; Department of Surgery, Houston Methodist Hospital, Houston, Texas.
| | - Katherine K Perez
- Houston Methodist Research Institute, Houston, Texas; Department of Pharmacy Services, Houston Methodist Hospital, Houston, Texas
| | - Michael L Johnson
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | - Hua Chen
- Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, Texas
| | | | - Elsie Rizk
- Houston Methodist Research Institute, Houston, Texas
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Wassef M, Mukhtar A, Nabil A, Ezzelarab M, Ghaith D. Care Bundle Approach to Reduce Surgical Site Infections in Acute Surgical Intensive Care Unit, Cairo, Egypt. Infect Drug Resist 2020; 13:229-236. [PMID: 32095080 PMCID: PMC6995287 DOI: 10.2147/idr.s236814] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/14/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Surgical site infections (SSIs) are one of the most frequently reported hospital acquired infections associated with significant spread of antibiotic resistance. Purpose We aimed to evaluate a bundle-based approach in reducing SSI at acute surgical intensive care unit of the Emergency Hospital of Cairo University. Patients and Methods Our prospective study ran from March 2018 to February 2019 and used risk assessment. The study was divided into three phases. Phase I: (pre-bundle phase) for 5 months; data collection, active surveillance of the SSIs, screening for OXA-48 producing Enterobacteriaceae and multidrug resistant Acinetobacter baumannii colonizers using Chrom agars were carried out. Phase II: (bundle-implementation) a 6-S bundle approach included education, training and postoperative bathing with Chlorhexidine Gluconate in collaboration with the infection control team. Finally, Phase III: (post-implementation) for estimation of compliance, rates of colonization, and infection. Results Phase I encompassed 177 patients, while Phase III included 93 patients. A significant reduction of colonization from 24% to 15% (p<0.001) was observed. Similarly, a decrease of SSI from 27% to 15% (p=0.02) was noticed. A logistic regression was performed to adjust for confounding in the implementation of the bundle and we found a 70% reduction of SSI odd's ratio (OR's ratio = 0.3) confidence interval (95% CI 0.14-0.6) with significant Apache II (p=0.04), type of wound; type II (p=0.002), type III (p=0.001) and duration of surgery (p=0.04) as independent risk factors for SSI. Klebsiella pneumoniae was the most prevalent organism during phase I (34.7%). On the other hand, A. baumannii was the commonest organism to be isolated during phase III with (38.5%) preceding K. pneumoniae (30%). Conclusion Our study demonstrated that the implementation of a multidisciplinary bundle containing evidence-based interventions was associated with a significant reduction of colonization and SSIs and was met with staff approval and acceptable compliance.
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Affiliation(s)
- Mona Wassef
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mukhtar
- Department of Anesthesia and Critical Care, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Nabil
- Department of General Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Moushira Ezzelarab
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Ghaith
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
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The efficacy of a simulated tunnel washer process on removal and destruction of Clostridioides difficile spores from health care textiles. Am J Infect Control 2019; 47:1375-1381. [PMID: 31239175 DOI: 10.1016/j.ajic.2019.04.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Research on reducing Clostridioides difficile spore contamination of textiles via laundering is needed. We evaluated the sporicidal properties of 5 laundry chemicals and then determined the ability of a peracetic acid (PAA) laundry cycle to inactivate and/or remove spores from cotton swatches during a simulated tunnel washer (TW) process. METHODS In phase I, spore-inoculated swatches were immersed in alkaline detergent, sodium hypochlorite, hydrogen peroxide, or PAA for 8 minutes. In phase II, inoculated swatches were passed through a simulated 24-minute TW process employing 5 wash liquids. Spore survivors on swatches and in test chemical fluids in both studies were enumerated using standard microbiologic assay methods. RESULTS In phase I, hypochlorite solutions achieved >5 log10 spore reductions on swatches and >3 log10 reductions for wash solutions. PAA achieved minimal spore reduction in the wash solution (0.26 log10). In phase II, the PAA equilibrium-containing process achieved a >5 log10 spore reduction on swatches. In wash solution tests, the cumulative spore reduction peaked at >3.08 log10 in the final module. CONCLUSIONS Sodium hypochlorite as a laundry additive is sporicidal. The cumulative effects of a TW process, coupled with a PAA bleach agent at neutral pH, may render textiles essentially free of C difficile spore contamination.
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Association between chlorhexidine gluconate concentrations and resistant bacterial bioburden on skin. Infect Control Hosp Epidemiol 2019; 40:1430-1432. [PMID: 31601280 DOI: 10.1017/ice.2019.265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We studied the association between chlorhexidine gluconate (CHG) concentration on skin and resistant bacterial bioburden. CHG was almost always detected on the skin, and detection of methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, and vancomycin-resistant Enterococcus on skin sites was infrequent. However, we found no correlation between CHG concentration and bacterial bioburden.
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Huang SS. Chlorhexidine-based decolonization to reduce healthcare-associated infections and multidrug-resistant organisms (MDROs): who, what, where, when, and why? J Hosp Infect 2019; 103:235-243. [PMID: 31494130 DOI: 10.1016/j.jhin.2019.08.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
Body surface decolonization with chlorhexidine bathing and nasal mupirocin has become a simple solution for prevention of healthcare-associated infections. The clinical trial evidence for this practice will be reviewed to understand who benefits from this practice, for what reasons, and at what times. The method of bathing and nasal decolonization will also be discussed as proper application is needed for maximal effectiveness. Finally, the conflict between current effectiveness and future potential for fueling resistance is considered.
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Affiliation(s)
- S S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California, USA.
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Lewis SR, Schofield‐Robinson OJ, Rhodes S, Smith AF. Chlorhexidine bathing of the critically ill for the prevention of hospital-acquired infection. Cochrane Database Syst Rev 2019; 8:CD012248. [PMID: 31476022 PMCID: PMC6718196 DOI: 10.1002/14651858.cd012248.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hospital-acquired infection is a frequent adverse event in patient care; it can lead to longer stays in the intensive care unit (ICU), additional medical complications, permanent disability or death. Whilst all hospital-based patients are susceptible to infections, prevalence is particularly high in the ICU, where people who are critically ill have suppressed immunity and are subject to increased invasive monitoring. People who are mechanically-ventilated are at infection risk due to tracheostomy and reintubation and use of multiple central venous catheters, where lines and tubes may act as vectors for the transmission of bacteria and may increase bloodstream infections and ventilator-associated pneumonia (VAP). Chlorhexidine is a low-cost product, widely used as a disinfectant and antiseptic, which may be used to bathe people who are critically ill with the aim of killing bacteria and reducing the spread of hospital-acquired infections. OBJECTIVES To assess the effects of chlorhexidine bathing on the number of hospital-acquired infections in people who are critically ill. SEARCH METHODS In December 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trial registries for ongoing and unpublished studies, and checked reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared chlorhexidine bathing with soap-and-water bathing of patients in the ICU. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data and undertook risk of bias and GRADE assessment of the certainty of the evidence . MAIN RESULTS We included eight studies in this review. Four RCTs included a total of 1537 individually randomised participants, and four cluster-randomised cross-over studies included 23 randomised ICUs with 22,935 participants. We identified one study awaiting classification, for which we were unable to assess eligibility.The studies compared bathing using 2% chlorhexidine-impregnated washcloths or dilute solutions of 4% chlorhexidine versus soap-and-water bathing or bathing with non-antimicrobial washcloths.Eight studies reported data for participants who had a hospital-acquired infection during the ICU stay. We are uncertain whether using chlorhexidine for bathing of critically ill people reduces the rate of hospital-acquired infection, because the certainty of the evidence is very low (rate difference 1.70, 95% confidence interval (CI) 0.12 to 3.29; 21,924 participants). Six studies reported mortality (in hospital, in the ICU, and at 48 hours). We cannot be sure whether using chlorhexidine for bathing of critically-ill people reduces mortality, because the certainty of the evidence is very low (odds ratio 0.87, 95% CI 0.76 to 0.99; 15,798 participants). Six studies reported length of stay in the ICU. We noted that individual studies found no evidence of a difference in length of stay; we did not conduct meta-analysis because data were skewed. It is not clear whether using chlorhexidine for bathing of critically ill people reduced length of stay in the ICU, because the certainty of the evidence is very low. Seven studies reported skin reactions as an adverse event, and five of these reported skin reactions which were thought to be attributable to the bathing solution. Data in these studies were reported inconsistently and we were unable to conduct meta-analysis; we cannot tell whether using chlorhexidine for bathing of critically ill people reduced adverse events, because the certainty of the evidence is very low.We used the GRADE approach to downgrade the certainty of the evidence of each outcome to very low. For all outcomes, we downgraded evidence because of study limitations (most studies had a high risk of performance bias, and we noted high risks of other bias in some studies). We downgraded evidence due to indirectness, because some participants in studies may have had hospital-acquired infections before recruitment. We noted that one small study had a large influence on the effect for hospital-acquired infections, and we assessed decisions made in analysis of some cluster-randomised cross-over studies on the effect for hospital-acquired infections and for mortality; we downgraded the evidence for these outcomes due to inconsistency. We also downgraded the evidence on length of stay in the ICU, because of imprecision. Data for adverse events were limited by few events and so we downgraded for imprecision. AUTHORS' CONCLUSIONS Due to the very low-certainty evidence available, it is not clear whether bathing with chlorhexidine reduces hospital-acquired infections, mortality, or length of stay in the ICU, or whether the use of chlorhexidine results in more skin reactions.
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Affiliation(s)
- Sharon R Lewis
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Oliver J Schofield‐Robinson
- Royal Lancaster InfirmaryLancaster Patient Safety Research UnitPointer Court 1, Ashton RoadLancasterUKLA1 4RP
| | - Sarah Rhodes
- University of ManchesterDivision of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and HealthManchesterUKM13 9PL
| | - Andrew F Smith
- Royal Lancaster InfirmaryDepartment of AnaesthesiaAshton RoadLancasterLancashireUKLA1 4RP
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Abstract
PURPOSE OF REVIEW Hospital-acquired pneumonia (HAP) is the leading cause of death from hospital-acquired infection. Little work has been done on strategies for prevention of HAP. This review aims to describe potential HAP prevention strategies and the evidence supporting them. Oral care and aspiration precautions may attenuate some risk for HAP. Oral and digestive decontamination with antibiotics may be effective but could increase risk for resistant organisms. Other preventive measures, including isolation practices, remain theoretical or experimental. RECENT FINDINGS Hospital-acquired pneumonia occurs because of pharyngeal colonization with pathogenic organisms and subsequent aspiration of these pathogens. SUMMARY Most potential HAP prevention strategies remain unproven.
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Fan CY, Lee WT, Hsu TC, Lee CH, Wang SP, Chen WS, Huang CH, Lee CC. Effect of chlorhexidine bathing on colonization or infection with Acinetobacter baumannii: a systematic review and meta-analysis. J Hosp Infect 2019; 103:284-292. [PMID: 31404567 DOI: 10.1016/j.jhin.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/05/2019] [Indexed: 12/28/2022]
Abstract
Healthcare-associated infections (HAIs) caused by multi-drug-resistant Gram-negative bacteria (MDRGNB) have increased prevalence in intensive care units (ICUs). A common strategy to prevent HAIs is bathing patients with chlorhexidine gluconate (CHG). However, the effectiveness of CHG bathing against multidrug-resistant Acinetobacter baumannii (MDRAB) is still controversial. The aim of this study was to perform a systematic review and meta-analysis of the effectiveness of CHG bathing on Acinetobacter baumannii colonization and infection in the ICU setting. A systematic literature search of PubMed, EMBASE, Web of Science and CINAHL was performed from inception through to June 2018. Randomized controlled trials (RCTs), pre-post studies, or interrupted time series (ITS) studies were included. The numbers of patients with/without colonization or infection of A. baumannii in the experimental or control groups were extracted from each study. Quality assessment was performed by the related instruments of National Institute of Health. Pooled risk ratios (RRs) were calculated using the random-effects model. One RCT and 12 pre-post or ITS studies comprising 18,217 patients were included, of which 8069 were in the CHG bathing arm and 9051 in the control arm. CHG bathing was associated with a reduced colonization of A. baumannii (RR, 0.66; 95% confidence interval: 0.57-0.77; P<0.001). Chlorhexidine at 4% showed a better effect than 2% chlorhexidine (meta-regression P=0.044). CHG bathing was associated with a non-significant reduction of infection (pooled RR 0.41, 95% CI: 0.13-1.25). This study suggests that CHG bathing significantly reduces colonization of A. baumannii in the ICU setting. However, more trials are needed to confirm whether CHG bathing can reduce infections with A. baumannii.
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Affiliation(s)
- C-Y Fan
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - W-T Lee
- Department of Medicine, The University of Queensland, Queensland, Australia
| | - T-C Hsu
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - C-H Lee
- Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - S-P Wang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - W-S Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - C-H Huang
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan
| | - C-C Lee
- Department of Emergency Medicine, National Taiwan University, Taipei, Taiwan.
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Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S, Hraiech S, Jung B, Kipnis E, Launey Y, Luyt C, Margetis D, Michel F, Mokart D, Montravers P, Monsel A, Nseir S, Pugin J, Roquilly A, Velly L, Zahar J, Bruyère R, Chanques G. Pneumonies associées aux soins de réanimation* RFE commune SFAR–SRLF. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Musuuza JS, Guru PK, O'Horo JC, Bongiorno CM, Korobkin MA, Gangnon RE, Safdar N. The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC Infect Dis 2019; 19:416. [PMID: 31088521 PMCID: PMC6518712 DOI: 10.1186/s12879-019-4002-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/17/2019] [Indexed: 01/14/2023] Open
Abstract
Background Chlorhexidine gluconate (CHG) bathing of hospitalized patients may have benefit in reducing hospital-acquired bloodstream infections (HABSIs). However, the magnitude of effect, implementation fidelity, and patient-centered outcomes are unclear. In this meta-analysis, we examined the effect of CHG bathing on prevention of HABSIs and assessed fidelity to implementation of this behavioral intervention. Methods We undertook a meta-analysis by searching Medline, EMBASE, CINAHL, Scopus, and Cochrane’s CENTRAL registry from database inception through January 4, 2019 without language restrictions. We included randomized controlled trials, cluster randomized trials and quasi-experimental studies that evaluated the effect of CHG bathing versus a non-CHG comparator for prevention of HABSIs in any adult healthcare setting. Studies of pediatric patients, of pre-surgical CHG use, or without a non-CHG comparison arm were excluded. Outcomes of this study were HABSIs, patient-centered outcomes, such as patient comfort during the bath, and implementation fidelity assessed through five elements: adherence, exposure or dose, quality of the delivery, participant responsiveness, and program differentiation. Three authors independently extracted data and assessed study quality; a random-effects model was used. Results We included 26 studies with 861,546 patient-days and 5259 HABSIs. CHG bathing markedly reduced the risk of HABSIs (IRR = 0.59, 95% confidence interval [CI]: 0.52–0.68). The effect of CHG bathing was consistent within subgroups: randomized (0.67, 95% CI: 0.53–0.85) vs. non-randomized studies (0.54, 95% CI: 0.44–0.65), bundled (0.66, 95% CI: 0.62–0.70) vs. non-bundled interventions (0.51, 95% CI: 0.39–0.68), CHG impregnated wipes (0.63, 95% CI: 0.55–0.73) vs. CHG solution (0.41, 95% CI: 0.26–0.64), and intensive care unit (ICU) (0.58, 95% CI: 0.49–0.68) vs. non-ICU settings (0.56, 95% CI: 0.38–0.83). Only three studies reported all five measures of fidelity, and ten studies did not report any patient-centered outcomes. Conclusions Patient bathing with CHG significantly reduced the incidence of HABSIs in both ICU and non-ICU settings. Many studies did not report fidelity to the intervention or patient-centered outcomes. For sustainability and replicability essential for effective implementation, fidelity assessment that goes beyond whether a patient received an intervention or not should be standard practice particularly for complex behavioral interventions such as CHG bathing. Trial registration Study registration with PROSPERO CRD42015032523. Electronic supplementary material The online version of this article (10.1186/s12879-019-4002-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jackson S Musuuza
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - John C O'Horo
- Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Connie M Bongiorno
- Bio-Medical Library, University of Minnesota Libraries, Minneapolis, MN, USA
| | - Marc A Korobkin
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ronald E Gangnon
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
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Targeting Catheter-Associated Urinary Tract Infections in a Trauma Population: A 5-S Bundle Preventive Approach. J Trauma Nurs 2019; 25:366-373. [PMID: 30395037 DOI: 10.1097/jtn.0000000000000403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Complications from catheter-associated urinary tract infections (CAUTIs) can cause morbidity and mortality. Our institution's Trauma Quality and Improvement Program analysis identified CAUTIs as an outlier complication in our trauma population. This study aimed to determine whether implemented measures would reduce CAUTI rates in trauma population. A 5-S CAUTI bundle was implemented. Its effects were measured on a prospectively collected dataset of adult trauma patients using our Trauma Registry during the 4-year study period. Implemented measures included (1) staff education, (2) bladder catheter stabilization, (3) patient and caregiver education, (4) keeping the collection bag below the bladder and above the floor, and (5) daily evaluations for discontinuation. Chi-squared and t-test analyses were used with significance defined as p < .05. Twelve thousand nine hundred and sixty-two trauma patients were admitted to trauma service during the 4-year study period. Of these, 94 developed CAUTIs, with an average age of 67 years and 56% were females. The average injury severity score was 16 in patients with CAUTIs compared with 9 in non-CAUTI patients (p < .0002). In the index year, CAUTIs occurred in 41 out of 3,054 (1.34%), the following year there were 34 out of 3,455 (0.98%), in 2016 there were 11 out of 3,246 (0.33%), and 8 out of 3,207 (0.25%) in 2017 (p < .001). Results demonstrated an 80% reduction in CAUTI rate. Execution of the 5-S CAUTI bundle resulted in a significant 80% reduction in CAUTI rate in our trauma population.
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Sturgeon LP, Garrett-Wright D, Lartey G, Jones MS, Bormann L, House S. A descriptive study of bathing practices in acute care facilities in the United States. Am J Infect Control 2019; 47:23-26. [PMID: 30172611 DOI: 10.1016/j.ajic.2018.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patient bathing basins are a potential source of health care-acquired infections. This descriptive study was designed to describe current patient bathing procedures and the cleaning and storage of disposable bath basins after use. METHODS After instrument validation, a 20-item questionnaire designed by the researchers was delivered electronically to infection prevention professionals working in acute care facilities in the United States. Descriptive statistics including frequencies and percentages were used to analyze the data. RESULTS A total of 344 participants completed the survey. Of those responding, most were employed in facilities with ≤300 beds and accredited by the Joint Commission. Many of the facility staff assisting patients with bathing were nursing aides. Participants reported varying bathing procedures in their facilities. CONCLUSIONS A collaborative approach is needed to ensure standard and efficient procedures that focus on quality, safety, and patient satisfaction. A mechanism to continually evaluate patient bathing practices should also be developed to address evolving changes in the health care system.
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Díaz E, Turégano C. Daily skin antisepsis and hygiene in the critically ill patient. Med Intensiva 2018; 43 Suppl 1:13-17. [PMID: 30482557 DOI: 10.1016/j.medin.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/08/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022]
Abstract
Hygiene and skin care of patients admitted to the Intensive Care Unit (ICU) are part of basic care. For some years there has been evidence of skin colonization by multiresistant gramnegative and grampositive pathogens. The increase in nosocomial infections due to multiresistant microorganisms has led to evaluation of the role of the use of antiseptics, mainly chlorhexidine, as a strategy for reducing the number of such infections. This article reviews the current situation of this strategy, as well as the positioning of the authors in relation to the spreading of its use in ICUs. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Affiliation(s)
- E Díaz
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
| | - C Turégano
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
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Agarwal N, Agarwal P, Querry A, Mazurkiewicz A, Tempel ZJ, Friedlander RM, Gerszten PC, Hamilton DK, Okonkwo DO, Kanter AS. Implementation of an infection prevention bundle and increased physician awareness improves surgical outcomes and reduces costs associated with spine surgery. J Neurosurg Spine 2018; 29:108-114. [DOI: 10.3171/2017.11.spine17436] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPrevious studies have demonstrated the efficacy of infection prevention protocols in reducing infection rates. This study investigated the effects of the development and implementation of an infection prevention protocol that was augmented by increased physician awareness of spinal fusion surgical site infection (SSI) rates and resultant cost savings.METHODSA cohort clinical investigation over a 10-year period was performed at a single tertiary spine care academic institution. Preoperative infection control measures (chlorohexidine gluconate bathing, Staphylococcus aureus nasal screening and decolonization) followed by postoperative infection control measures (surgical dressing care) were implemented. After the implementation of these infection control measures, an awareness intervention was instituted in which all attending and resident neurosurgeons were informed of their individual, independently adjudicated spinal fusion surgery infection rates and rankings among their peers. During the course of these interventions, the overall infection rate was tracked as well as the rates for those neurosurgeons who complied with the preoperative and postoperative infection control measures (protocol group) and those who did not (control group).RESULTSWith the implementation of postoperative surgical dressing infection control measures and physician awareness, the postoperative spine surgery infection rate decreased by 45% from 3.8% to 2.1% (risk ratio 0.55; 95% CI 0.32–0.93; p = 0.03) for those in the protocol cohort, resulting in an estimated annual cost savings of $291,000. This reduction in infection rate was not observed for neurosurgeons in the control group, although the overall infection rate among all neurosurgeons decreased by 54% from 3.3% to 1.5% (risk ratio 0.46; 95% CI 0.28–0.73; p = 0.0013).CONCLUSIONSA novel paradigm for spine surgery infection control combined with physician awareness methods resulted in significantly decreased SSI rates and an associated cost reduction. Thus, information sharing and physician engagement as a supplement to formal infection control measures result in improvements in surgical outcomes and costs.
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Affiliation(s)
| | - Prateek Agarwal
- 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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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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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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Leone M, Bouadma L, Bouhemad B, Brissaud O, Dauger S, Gibot S, Hraiech S, Jung B, Kipnis E, Launey Y, Luyt CE, Margetis D, Michel F, Mokart D, Montravers P, Monsel A, Nseir S, Pugin J, Roquilly A, Velly L, Zahar JR, Bruyère R, Chanques G. Hospital-acquired pneumonia in ICU. Anaesth Crit Care Pain Med 2018; 37:83-98. [DOI: 10.1016/j.accpm.2017.11.006] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
PURPOSE OF REVIEW Infectious disease outbreaks in the critical care setting are common and serious consequence. This article reviews and summarizes recent outbreaks in the adult ICUs. RECENT FINDINGS Outbreaks of multidrug-resistant bacteria, fungi, and emerging viruses in ICUs from different countries are common. Outbreak investigation relies on epidemiologic methods, microbiologic studies, and molecular typing methods. Overuse of antibiotics, gaps in implementing infection prevention measures, and contaminated environment are common causes of ICU outbreaks. ICU staff awareness of and preparedness for such outbreaks are crucial for outbreak prevention and control. Specific infection control measures vary according to outbreak transmission mode and cause. SUMMARY Outbreaks remain a significant threat to healthcare systems. Proper implementation of infection prevention practices and judicious use of antibiotics are needed for outbreak prevention in adult ICUs. Surveillance, proper outbreak investigation, adherence to infection prevention and control measures, and thorough disinfection of contaminated areas are required to successfully manage outbreaks.
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Abstract
Colonization of the extremely preterm infant's gastrointestinal tract and skin begins in utero and is influenced by a variety of factors, the most important including gestational age and environmental exposures. The composition of the intestinal and skin microbiota influences the developing innate and adaptive immune responses with short-term and long-term consequences including altered risks for developing necrotizing enterocolitis, sepsis, and a wide variety of microbe-related diseases of children and adults. Alteration of the composition of the microbiota to decrease disease risk is particularly appealing for this ultra-high-risk cohort that is brand new from an evolutionary standpoint.
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Li Bassi G, Senussi T, Aguilera Xiol E. Prevention of ventilator-associated pneumonia. Curr Opin Infect Dis 2017; 30:214-220. [DOI: 10.1097/qco.0000000000000358] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Venter H, Henningsen ML, Begg SL. Antimicrobial resistance in healthcare, agriculture and the environment: the biochemistry behind the headlines. Essays Biochem 2017; 61:1-10. [PMID: 28258225 PMCID: PMC5900547 DOI: 10.1042/ebc20160053] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/29/2022]
Abstract
The crisis of antimicrobial resistance (AMR) is one of the most serious issues facing us today. The scale of the problem is illustrated by the recent commitment of Heads of State at the UN to coordinate efforts to curb the spread of AMR infections. In this review, we explore the biochemistry behind the headlines of a few stories that were recently published in the public media. We focus on examples from three different issues related to AMR: (i) hospital-acquired infections, (ii) the spread of resistance through animals and/or the environment and (iii) the role of antimicrobial soaps and other products containing disinfectants in the dissemination of AMR. Although these stories stem from three very different settings, the underlying message in all of them is the same: there is a direct relationship between the use of antimicrobials and the development of resistance. In addition, one type of antimicrobial could select for cross-resistance to another type and/or for multidrug resistance. Therefore, we argue the case for increased stewardship to not only cover clinical use of antibiotics, but also the use of antimicrobials in agriculture and stewardship of our crucially important biocides such as chlorhexidine.
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Affiliation(s)
- Henrietta Venter
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia
| | - Michael L Henningsen
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia
| | - Stephanie L Begg
- School of Pharmacy and Medical Sciences, Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5000, Australia
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Wang EW, Layon AJ. Chlorhexidine gluconate use to prevent hospital acquired infections-a useful tool, not a panacea. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:14. [PMID: 28164099 DOI: 10.21037/atm.2017.01.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Elizabeth Wenqian Wang
- Department of Hospital Medicine, The Medicine Institute, The Geisinger Health System, Danville, PA 17822-2037, USA
| | - A Joseph Layon
- Department of Critical Care Medicine, The Medicine Institute, The Geisinger Health System, Danville, PA 17822-2037, USA
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Popovich KJ. Another look at CHG bathing in a surgical intensive care unit. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:13. [PMID: 28164098 DOI: 10.21037/atm.2016.12.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kyle J Popovich
- Rush University Medical Center, Stroger Hospital of Cook County, Chicago, Illinois, USA
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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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Chávez-Moreno S, Camacho-Ortiz A. Chlorhexidine bathing every other day still does the trick, but it may come at a cost. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:555. [PMID: 28149916 DOI: 10.21037/atm.2016.12.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Susana Chávez-Moreno
- Coordination of Hospital Epidemiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, NL, Mexico
| | - Adrián Camacho-Ortiz
- Coordination of Hospital Epidemiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, NL, Mexico
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The Building Case for Chlorhexidine Decolonization in the Prevention of Healthcare-Associated Infections. Crit Care Med 2016; 44:1938-9. [PMID: 27635485 DOI: 10.1097/ccm.0000000000001939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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