Skip to main content
×
Home
    • Aa
    • Aa

Daily Bathing with Chlorhexidine-Based Soap and the Prevention of Staphylococcus aureus Transmission and Infection

  • Melissa A. Viray (a1), James C. Morley (a2), Craig M. Coopersmith (a3), Marin H. Kollef (a1), Victoria J. Fraser (a1) and David K. Warren (a1)...
Abstract
Objective.

Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive care unit (ICU)-acquired S. aureus infection among ICU patients.

Design.

Prospective pre-post-intervention study with control unit.

Setting.

A 1,250-bed tertiary care teaching hospital.

Patients.

Medical and surgical ICU patients.

Methods.

Active surveillance for MRSA colonization was performed in both ICUs. In June 2005, a chlorhexidine bathing protocol was implemented in the surgical ICU. Changes in S. aureus transmission and infection rate before and after implementation were analyzed using time-series methodology.

Results.

The intervention unit had a 20.68% decrease in MRSA acquisition after institution of the bathing protocol (12.64 cases per 1,000 patient-days at risk before the intervention vs 10.03 cases per 1,000 patient-days at risk after the intervention; β, −2.62 [95% confidence interval (CI), −5.19 to −0.04]; P = .046). There was no significant change in MRSA acquisition in the control ICU during the study period (10.97 cases per 1,000 patient-days at risk before June 2005 vs 11.33 cases per 1,000 patient-days at risk after June 2005; β, −11.10 [95% CI, −37.40 to 15.19]; P = .40). There was a 20.77% decrease in all S. aureus (including MRSA) acquisition in the intervention ICU from 2002 through 2007 (19.73 cases per 1,000 patient-days at risk before the intervention to 15.63 cases per 1,000 patient-days at risk after the intervention [95% CI, −7.25 to −0.95]; P = .012)]. The incidence of ICU-acquired MRSA infections decreased by 41.37% in the intervention ICU (1.96 infections per 1,000 patient-days at risk before the intervention vs 1.15 infections per 1,000 patient-days at risk after the intervention; P = .001).

Conclusions.

Institution of daily chlorhexidine bathing in an ICU resulted in a decrease in the transmission of S. aureus, including MRSA. These data support the use of routine daily chlorhexidine baths to decrease rates of S. aureus transmission and infection.

Copyright
Corresponding author
Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110 (dwarren@dom.wustl.edu)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. DJ Anderson , KS Kaye , LF Chen , et al.Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLOS ONE 2009;4:e8305.

3. C Rubio-Terres , J Garau , S Grau , L Martinez-Martinez . Cost of bacteraemia caused by methicillin-resistant vs. methicillin-sus-ceptible Staphylococcus aureus in Spain: a retrospective cohort study. Clin Microbiol Infect 2010;16:722728.

4. ME de Kraker , M Wolkewitz , PG Davey et al.Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother 2011;55:15981605.

5. H Hanberger , S Walther , M Leone et al.Increased mortality associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in the intensive care unit: results from the EPIC II study. Int J Antimicrob Agents 2011;38:331335.

6. EA Mortimer Jr, PJ Lipsitz , E Wolinksky , AJ Gonzaga , CH Rammelkamp Jr. Transmission of staphylococci between newborns: importance of the hands to personnel. Am J Dis Child 1962;104:289295.

7. H Humphreys . Can we do better in controlling and preventing methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU)? Eur J Clin Microbiol Infect Dis 2008;27: 409413.

8. MW Climo , KA Sepkowitz , G Zuccotti , et al.The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Entero-coccus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009; 37:18581865.

9. MO Vernon , MK Hayden , WE Trick , RA Hayes , DW Blom , RA Weinstein . 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.

10. MW Climo , DS Yokoe , DK Warren , et al.Effect of daily Chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533542.

11. R Batra , BS Cooper , C Whiteley , AK Patel , D Wyncoll , JD Edge-worth . Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillinresistant Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2010;50:210217.

15. SS Huang , E Septimus , K Kleinman , et al.Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:22552265.

16. HL Evans , TH Dellit , J Chan , AB Nathens , RV Maier , J Cuschieri . Effect of Chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg 2010;145: 240246.

17. IM Gould , FM MacKenzie , G MacLennan , D Pacitti , EJ Watson , DW Noble . Topical antimicrobials in combination with admission screening and barrier precautions to control endemic methicillin-resistant Staphylococcus aureus in an intensive care unit. Int f Antimicrob Agents 2007;29:536543.

18. SC Bleasdale , WE Trick , IM Gonzalez , RD Lyles , MK Hayden , RA Weinstein . Effectiveness of Chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:20732079.

20. AG Perry , PA Potter . Clinical Nursing Skills and Techniques. 5th ed. St. Louis: Mosby, 2001.

22. DWK Andrews , W Ploberger . Optimal tests when a nuisance parameter is present only under the alternative. Econometrica 1994;62:13831414.

24. AM Milstone , A Elward , X Song , et al.Daily Chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial. Lancet 2013;381:10991106.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 48 *
Loading metrics...

Abstract views

Total abstract views: 130 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 26th March 2017. This data will be updated every 24 hours.