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

Published online by Cambridge University Press:  01 March 2018

Yoona Rhee ,
Louisa J. Palmer ,
Koh Okamoto ,
Sean Gemunden ,
Khaled Hammouda ,
Sarah K. Kemble ,
Michael Y. Lin ,
Karen Lolans ,
Louis Fogg  and
Derek Guanaga
...Show all authors
Yoona Rhee*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
Louisa J. Palmer*
Affiliation:
Department of Anesthesiology, Perioperative, Critical Care and Pain Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts Surgical Critical Care Translational Research (STAR) Center, Brigham and Women’s Hospital, Boston, Massachusetts
Koh Okamoto
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
Sean Gemunden
Affiliation:
Department of Anesthesiology, Perioperative, Critical Care and Pain Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts Surgical Critical Care Translational Research (STAR) Center, Brigham and Women’s Hospital, Boston, Massachusetts
Khaled Hammouda
Affiliation:
Department of Anesthesiology, Perioperative, Critical Care and Pain Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts Surgical Critical Care Translational Research (STAR) Center, Brigham and Women’s Hospital, Boston, Massachusetts
Sarah K. Kemble
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois Chicago Department of Public Health, Chicago, Illinois
Michael Y. Lin
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
Karen Lolans
Affiliation:
Department of Pathology, Rush University Medical Center, Chicago, Illinois
Louis Fogg
Affiliation:
Department of Nursing, Rush University Medical Center, Chicago, Illinois
Derek Guanaga
Affiliation:
Department of Anesthesiology, Perioperative, Critical Care and Pain Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts Surgical Critical Care Translational Research (STAR) Center, Brigham and Women’s Hospital, Boston, Massachusetts
Deborah S. Yokoe
Affiliation:
Department of Medicine, Division of Infectious Diseases, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
Robert A. Weinstein
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois Division of Infectious Diseases, Department of Internal Medicine, Cook County Health and Hospital System, Chicago, Illinois
Gyorgy Frendl
Affiliation:
Department of Anesthesiology, Perioperative, Critical Care and Pain Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts Surgical Critical Care Translational Research (STAR) Center, Brigham and Women’s Hospital, Boston, Massachusetts
Mary K. Hayden*
Affiliation:
Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois Department of Pathology, Rush University Medical Center, Chicago, Illinois
*
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).
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).
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).
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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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 4 , April 2018 , pp. 405 - 411
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

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.

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