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Differential Effects of Chlorhexidine Skin Cleansing Methods on Residual Chlorhexidine Skin Concentrations and Bacterial Recovery

  • Yoona Rhee (a1), Louisa J. Palmer (a2) (a3), Koh Okamoto (a1), Sean Gemunden (a2) (a3), Khaled Hammouda (a2) (a3), Sarah K. Kemble (a1) (a4), Michael Y. Lin (a1), Karen Lolans (a5), Louis Fogg (a6), Derek Guanaga (a2) (a3), Deborah S. Yokoe (a7), Robert A. Weinstein (a1) (a8), Gyorgy Frendl (a2) (a3), Mary K. Hayden (a1) (a5) and for the Centers for Disease Control and Prevention Epicenter Program...
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

Copyright
Corresponding author
Address correspondence to Yoona Rhee, MD, ScM, Division of Infectious Diseases, Rush University Medical Center, 600 South Paulina Street, Suite 143, Chicago, IL 60612 (Yoona_Rhee@rush.edu) or Mary K. Hayden, MD, Division of Infectious Diseases and Clinical Microbiology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612 (Mhayden@rush.edu) or Louisa Palmer, MBBS, and Gyorgy Frendl, MD, PhD, Brigham and Women’s Hospital, Department of Anesthesiology, CWN-L1, 75 Francis Street, Boston, MA 02115 (lpalmer4@bwh.harvard.edu and gfrendl@bwh.harvard.edu).
Footnotes
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PREVIOUS PRESENTATION. This study was presented in part at The Society for Healthcare Epidemiology of America Spring 2016 Conference, May 20, 2016, Atlanta, GA, USA, in a poster titled “Comparison of 2% Chlorhexidine Gluconate (CHG)— impregnated Cloth vs. 4% CHG Cleansing.”

a

First authors of equal contribution.

b

Senior authors of equal contribution.

Footnotes
References
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1. Davies, GE, Francis, J, Martin, AR, Rose, FL, Swain, G. 1:6-Di-4’-chlorophenyldiguanidohexane (hibitane); laboratory investigation of a new antibacterial agent of high potency. Brit J Pharmacol Chemother 1954;9:192196.
2. Van Strydonck, DA, Slot, DE, Van der Velden, U, Van der Weijden, F. Effect of a chlorhexidine mouthrinse on plaque, gingival inflammation and staining in gingivitis patients: a systematic review. J Clin Periodontol 2012;39:10421055.
3. Edmiston, CE Jr, Bruden, B, Rucinski, MC, Henen, C, Graham, MB, Lewis, BL. Reducing the risk of surgical site infections: does chlorhexidine gluconate provide a risk reduction benefit? Am J Infect Control 2013;41(5 Suppl):S49S55.
4. Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. New England J Med 2013;368:533542.
5. Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30:959963.
6. Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:20732079.
7. Vernon, MO, Hayden, MK, Trick, WE, et al. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166:306312.
8. Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009;37:18581865.
9. Borer, A, Gilad, J, Porat, N, et al. Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit. J Hosp Infect 2007;67:149155.
10. Petlin, A, Schallom, M, Prentice, D, et al. Chlorhexidine gluconate bathing to reduce methicillin-resistant Staphylococcus aureus acquisition. Crit Care Nurse 2014;34:1725; quiz 26.
11. Ritz, J, Pashnik, B, Padula, C, Simmons, K. Effectiveness of 2 methods of chlorhexidine bathing. J Nurs Care Qual 2012;27:171175.
12. Edmiston, CE Jr, Lee, CJ, Krepel, CJ, et al. Evidence for a standardized preadmission showering regimen to achieve maximal antiseptic skin surface concentrations of chlorhexidine gluconate, 4%, in surgical patients. JAMA Surg 2015;150:10271033.
13. Edmiston, CE Jr, Krepel, CJ, Seabrook, GR, Lewis, BD, Brown, KR, Towne, JB. Preoperative shower revisited: Can high topical antiseptic levels be achieved on the skin surface before surgical admission? J Am Coll Surg 2008;207:233239.
14. Hibiclens Drug Facts. Mölnlycke website. http://www.molnlycke.us/antiseptics/general-skin-cleansing/hibiclens-information/hibiclens-drug-facts/. Accessed December 3, 2017.
15. Popovich, KJ, Lyles, R, Hayes, R, et al. 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;33:889896.
16. Kampf, G. What is left to justify the use of chlorhexidine in hand hygiene? J Hosp Infect 2008;70(Suppl 1):2734.
17. Reichel, M, Heisig, P, Kampf, G. Pitfalls in efficacy testing—How important is the validation of neutralization of chlorhexidine digluconate? Ann Clin Microbiol Antimicrob 2008;7:20.
18. Cohen, J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Erlbaum; 1988.
19. Edmiston, CE Jr, Seabrook, GR, Johnson, CP, Paulson, DS, Beausoleil, CM. Comparative of a new and innovative 2% chlorhexidine gluconate-impregnated cloth with 4% chlorhexidine gluconate as topical antiseptic for preparation of the skin prior to surgery. Am J Infect Control 2007;35:8996.
20. Kampf, G. Acquired resistance to chlorhexidine—is it time to establish an ‘antiseptic stewardship’ initiative? J Hosp Infect 2016;94:213227.
21. Lin, MY, Lolans, K, Blom, DW, et al. The effectiveness of routine daily chlorhexidine gluconate bathing in reducing Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae skin burden among long-term acute care hospital patients. Infect Control Hosp Epidemiol 2014;35:440442.
22. Valenzuela, AS, Benomar, N, Abriouel, H, Canamero, MM, Lopez, RL, Galvez, A. Biocide and copper tolerance in enterococci from different sources. J Food Protect 2013;76:18061809.
23. Chlorhexidine Gluconate. Lexi-Comp Lexi-Drugs Online database website. http://online.lexi.com. Published 2007. Updated June 1, 2017. Accessed July 9, 2017. [Subscription required to view.].
24. Munoz-Price, LS, Hota, B, Stemer, A, Weinstein, RA. Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital. Infect Control Hosp Epidemiol 2009;30:10311035.
25. Swan, JT, Ashton, CM, Bui, LN, et al. Effect of chlorhexidine bathing every other day on prevention of hospital-acquired infections in the surgical ICU: a single-center, randomized controlled trial. Critical Care Med 2016;44:18221832.
26. Alserehi, H, Filippell, M, Emerick, M, et al. Chlorhexidine gluconate bathing practices and skin concentrations in intensive care unit patients. Am J Infect Control 2017. pii S0196–6553(17):3100231007; doi: 10.1016/j.ajic.2017.08.022.
27. Denton, GW. Chlorhexidine. In Block SS, ed. Disinfection, Sterilization, and Preservation. 5th edition. Philadelphia, PA: Lippincott Williams & Wilkins; 2001:321336.
28. Rupp, ME, Cavalieri, RJ, Lyden, E, et al. Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections. Infect Control Hosp Epidemiol 2012;33:10941100.
29. Naparstek, L, Carmeli, Y, Chmelnitsky, I, Banin, E, Navon-Venezia, S. Reduced susceptibility to chlorhexidine among extremely-drug-resistant strains of Klebsiella pneumoniae . J Hosp Infect 2012;81:1519.
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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