Highlights
- •Chlorhexidine is a widely use antiseptic in the hospital setting.
- •Whole body wash or impregnation of hospital attire with chlorhexidine proved to reduce bacterial counts.
- •The strategy was safe and effective.
Background
The use of chlorhexidine as a strategy to reduce nosocomial infections in patients
has been proven useful. Bacterial contamination of health care worker's uniforms during
routine patient care has been demonstrated to have potential for horizontal transmission
of pathogens.
Methods
We performed a prospective, open comparative trial. We included nurses who were in
direct patient care and evaluated clothing microbial growth during 3 interventions:
(1) participants were given a sterile surgical scrub (SSS) to put on the beginning
of the shift, (2) they were instructed to take a chlorhexidine bath (CHG-B) before
putting on the SSS, and (3) participants were given a chlorhexidine impregnated SSS
(CI-SSS). Cultures were obtained from 3 areas (chest pocket, chest, and abdominal)
at hour 0, 6, and 12 hours after the start of the shift.
Results
A total of 306 cultures processed with 17 bacterial groups. The uniform area with
the highest number of CFU was the abdomen (818 CFU), followed by the thorax (654 CFU).
Over 50% of the bacterial load occurred at 12 hours (1,092 CFU at 12 hours, 766 CFU
at 6 hours, and 184 CFU at 0 hour). There was a significant reduction in CFU when
SSS was compared to CHG-B (CFU mean = 12.5 [0-118] vs CFU mean = 3.5 [0-22], P = .003); and SSS versus CI-SSS (CFU mean = 12.5 [0-118] vs CFU mean = 3 [0-39], P = .007). No severe adverse events were reported.
Conclusions
Bacterial load in uniforms decreased when chlorhexidine was used (bathing of personnel
or impregnation) when compared to the use of a sterile uniform.
Key Words
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References
- Infections in acute care hospitals: 2014 updates.Infect Control Hosp Epidemiol. 2014; 35: 967-977
- Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital.Crit Care Med. 2006; 34: 2084-2089
- Health care-associated infections: A meta-analysis of costs and financial impact on the US health care system.JAMA Intern Med. 2013; 173: 2039-2046
- Chlorhexidine: expanding the armamentarium for infection control and prevention.Clin Infect Dis. 2007; 46: 274-281
- An intervention to decrease catheter-related bloodstream infections in the ICU.N Engl J Med. 2006; 355: 2725-2732
- Another look at CHG bathing in a surgical intensive care unit.Ann Transl Med. 2017; 5: 13
- Chlorhexidine gluconate to cleanse patients in a medical intensive care unit.Arch Intern Med. 2006; 166: 306
- Bacterial contamination of healthcare workers’ uniforms: a randomized controlled trial of antimicrobial scrubs.J Hosp Med. 2013; 8: 380-385
- 12-hour nursing shifts in critical care: a service evaluation.J Intensive Care Soc. 2018; 19: 214-218
- Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: a randomized controlled trial.J Hosp Med. 2011; 6: 177-182
- Bacterial contamination of surgical scrubs.Am J Orthop. 2012; 41: E69-E73
- Healthcare personnel attire and devices as fomites: a systematic review.Infect Control Hosp Epidemiol. 2016; 37: 1367-1373
- Simon-oke. Fomites : possible vehicle of nosocomial infections.J Public Heal Nutr. 2018; 1: 11-16
- Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review.Intensive Care Med. 2012; 38: 931-939
- Nursing and physician attire as possible source of nosocomial infections.Am J Infect Control. 2011; 39: 555-559
- A randomized trial to determine whether wearing short-sleeved white coats reduces the risk for pathogen transmission.Infect Control Hosp Epidemiol. 2018; 39: 233-234
- Chlorhexidine daily bathing: impact on health care-associated infections caused by gram-negative bacteria.Am J Infect Control. 2015; 43: 640-643
- Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability.Am J Med. 2012; 125: 505-511
- Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: a systematic review and meta-analysis of randomised crossover trials.Eurosurveillance. 2016; 21: 1-11
- 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
- Disinfection, sterilization and preservation (5th ed).Aust Infect Control. 2002; 7: 74
- Chlorhexidine: uses and adverse reactions.Dermatitis. 2013; 24: 112-118
- Acquired resistance to chlorhexidine—is it time to establish an ‘antiseptic stewardship’ initiative?.J Hosp Infect. 2016; 94: 213-227
Article info
Publication history
Published online: February 11, 2020
Footnotes
Conflicts of interest: None to report.
Identification
Copyright
© 2020 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
