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.
Key Words
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References
- Prevalence of colonization and infection with methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus and of Clostridium difficile infection in Canadian hospitals.Infect Control Hosp Epidemiol. 2013; 34: 687-693
- Management of multidrug-resistant organisms in health care settings, 2006.Am J Infect Control. 2007; 35: S165-93
- Economic analysis of vancomycin-resistant enterococci at a Canadian hospital: assessing attributable cost and length of stay.J Hosp Infect. 2013; 85: 54-59
- Insights into bacterial colonization of intensive care patients' skin: the effect of chlorhexidine daily bathing.Eur J Clin Microbiol Infect Dis. 2015; 34: 999-1004
- Chlorhexidine only works if applied correctly: use of a simple colorimetric assay to provide monitoring and feedback on effectiveness of chlorhexidine application.Infect Control Hosp Epidemiol. 2015; 36: 1095-1097
- Effect of daily chlorhexidine bathing on hospital-acquired infection.N Engl J Med. 2013; 368: 533-542
- Targeted versus universal decolonization to prevent ICU infection.N Engl J Med. 2013; 368: 2255-2265
- Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial.Lancet. 2013; 381: 1099-1106
- The efficacy of daily bathing with chlorhexidine for reducing healthcare-associated bloodstream infections: a meta-analysis.Infect Control Hosp Epidemiol. 2012; 33: 257-267
- Impact of chlorhexidine bathing on hospital-acquired infections among general medical patients.Infect Control Hosp Epidemiol. 2011; 32: 238-243
- Research on a vulnerable neighborhood-the Vancouver downtown eastside from 2001 to 2011.J Urban Health. 2013; 90: 559-573
- Community-associated methicillin-resistant Staphylococcus aureus is prevalent in wounds of community-based injection drug users.Epidemiol Infect. 2010; 138: 713-720
- A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates.Infect Control Hosp Epidemiol. 2014; 35: S21-31
- Universal ICU decolonization: an enhanced protocol.(Rockville (MD): Agency for Healthcare Research and Quality)2013 (AHRQ Publication No. 13-0052-EF)
- Multidrug-resistant organism & Clostridium difficile infection (MDRO/CDI) module.(Available from) (Accessed January 6, 2016)
- Induced sporicidal activity of chlorhexidine against Clostridium difficile spores under altered physical and chemical conditions.PLoS ONE. 2015; 10 (e0123809)
- Principles and procedures for blood cultures. CLSI document M47-A.(Wayne (PA): CLSI)2007
- WHO guidelines on hand hygiene in health care.(Available from) (Accessed January 7, 2016)
- Distribution of the antiseptic resistance genes qacA, qacB and qacC in 497 methicillin-resistant and -susceptible European isolates of Staphylococcus aureus.J Antimicrob Chemother. 2001; 47: 896-897
- Rapid and simultaneous detection of the chlorhexidine and mupirocin resistance genes qacA/B and mupA in clinical isolates of methicillin-resistant Staphylococcus aureus.Diagn Microbiol Infect Dis. 2013; 77: 270-272
- Susceptibilities to antiseptic agents and distribution of antiseptic-resistance genes qacA/B and smr of methicillin-resistant Staphylococcus aureus isolated in Asia during 1998 and 1999.J Med Microbiol. 2005; 54: 557-565
- Chlorhexidine and mupirocin susceptibility of methicillin-resistant Staphylococcus aureus isolates in the REDUCE-MRSA trial.J Clin Microbiol. 2016; (Aug 24. [Epub ahead of print])
- Performance standards for antimicrobial susceptibility testing; twenty-fifth informational supplement. CLSI document M100-S25.(Wayne, (PA): CLSI)2015
- Evaluation of epidemiological cut-off values indicates that biocide resistant subpopulations are uncommon in natural isolates of clinically-relevant microorganisms.PLoS ONE. 2014; 9 (e86669)
- Relationship between chlorhexidine gluconate skin concentration and microbial density on the skin of critically ill patients bathed daily with chlorhexidine gluconate.Infect Control Hosp Epidemiol. 2012; 33: 889-896
- Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections.Infect Control Hosp Epidemiol. 2012; 33: 1094-1100
- Chlorhexidine bathing and health care-associated infections: a randomized clinical trial.JAMA. 2015; 313: 369-378
- Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial.Lancet Infect Dis. 2014; 14: 31-39
- Hospital bath basins are frequently contaminated with multidrug-resistant human pathogens.Am J Infect Control. 2012; 40: 562-564
- Acceptibility of chlorhexidine gluconate (CHG) cloths for patient bathing on a medical unit.IPAC Canada 2015 National Education Conference, Victoria, BC2015 (June 15–17)
- Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital.Infect Control Hosp Epidemiol. 2009; 30: 1031-1035
- Reduced susceptibility to chlorhexidine in staphylococci: is it increasing and does it matter?.J Antimicrob Chemother. 2012; 67: 2547-2559
- Review and phylogenetic analysis of qac genes that reduce susceptibility to quaternary ammonium compounds in Staphylococcus species.Eur J Microbiol Immunol (Bp). 2015; 5: 44-61
- Prevalence of qacA/B genes and mupirocin resistance among methicillin-resistant Staphylococcus aureus (MRSA) isolates in the setting of chlorhexidine bathing without mupirocin.Infect Control Hosp Epidemiol. 2016; 37: 590-597
- Distribution of antiseptic resistance genes qacA, qacB, and smr in methicillin-resistant Staphylococcus aureus isolated in Toronto, Canada, from 2005 to 2009.Antimicrob Agents Chemother. 2011; 55: 2999-3001
- Cost-effectiveness of strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in an intensive care unit.Infect Control Hosp Epidemiol. 2015; 36: 17-27
- Cost savings of universal decolonization to prevent intensive care unit infection: implications of the REDUCE MRSA trial.Infect Control Hosp Epidemiol. 2014; 35: S23-31
- Reconsidering contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus.Infect Control Hosp Epidemiol. 2015; 36: 1163-1172
Article Info
Publication History
Published online: December 08, 2016
Footnotes
Previous presentation: Preliminary results of this study were presented at IDWeek 2015, October 7–11 2015, San Diego, CA.
Funding/support: Supported by Sage Products, LLP , who donated chlorhexidine gluconate cloths for the duration of the study and provided funding to develop the in-house polymerase chain reaction.
Disclaimer: Sage Products, LLP was not involved in the design and analysis of the study.
Conflicts of interest: None to report
Identification
Copyright
© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
