Hostname: page-component-7c8c6479df-94d59 Total loading time: 0 Render date: 2024-03-18T02:39:40.824Z Has data issue: false hasContentIssue false

Effectiveness of Routine Patient Cleansing with Chlorhexidine Gluconate for Infection Prevention in the Medical Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Kyle J. Popovich*
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Department of Medicine, Section of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
Bala Hota
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Department of Medicine, Section of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
Robert Hayes
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Department of Medicine, Section of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
Mary K. Hayden
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
*
Department of Medicine, Section of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 12th Floor, Chicago, IL 60612 (kyle_popovich@rush.edu)

Abstract

Background.

Controlled studies that took place in medical intensive care units (MICUs) have demonstrated that bathing patients with Chlorhexidine gluconate (CHG) can reduce skin colonization with potential pathogens and can lessen the risk of central venous catheter (CVC)-associated bloodstream infection (BSI).

Objective.

TO examine, without oversight of practice by research study staff, the effectiveness or real-world effect of patient cleansing with CHG on rates of CVC-associated BSI.

Design.

In the fall of 2005, the MICU at Rush University Medical Center discontinued bathing patients daily with soap and water and substituted skin cleansing with no-rinse, 2% CHG-impregnated cloths. This change was a clinical management decision without research input.

Setting.

A 21-bed MICU at Rush University Medical Center.

Patients.

Patients hospitalized in the MICU during the period from September 2004 through October 2006.

Methods.

In a pre-post study design, we gathered data from administrative and laboratory databases, infection control practitioner logs, and patient medical charts to compare rates of CVC-associated BSI and blood culture contamination between the baseline soap-and-water bathing period (September 2004-October 2005) and the CHG bathing period (November 2005-October 2006). Rates of secondary BSI, Clostridium difficile infection (CDI), ventilator-associated pneumonia (VAP), and urinary tract infection (UTI) served as control variables that were not expected to be affected by CHG bathing.

Results.

Bathing with CHG was associated with a statistically significant decrease in the rate of CVC-associated BSI (from 5.31 to 0.69 cases per 1,000 CVC-days; P = .006) and in the rate of blood culture contamination (from 6.99 to 4.1 cases per 1,000 patient-days; P = .04). Rates of secondary BSI, CDI, VAP, and UTI did not change significantly.

Conclusions.

In our analysis of real-world practice, daily bathing of MICU patients with CHG was effective at reducing rates of CVC-associated BSI and blood culture contamination. Controlled studies are needed to determine whether these beneficial effects extend outside the MICU.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Mermel, LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000;132:391402.Google Scholar
2.Safdar, N, Maki, DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004;30:6267.CrossRefGoogle ScholarPubMed
3.O'Grady, NP, Alexander, M, Dellinger, EP, et al.; Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002;51(RR-10):129.Google ScholarPubMed
4.Berenholtz, SM, Pronovost, PJ, Lipsett, PA, et al.Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 2004;32:20142020.CrossRefGoogle ScholarPubMed
5.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:27252732.Google Scholar
6.Edwards, JR, Peterson, KD, Andrus, ML, et al.National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290301.Google Scholar
7.Russell, AD, Day, MJ. Antibacterial activity of Chlorhexidine. J Hosp Infect 1993;25:229238.Google Scholar
8.Lio, PA, Kaye, ET. Topical antibacterial agents. Infect Dis Clin North Am 2004;18:717733.Google Scholar
9.Rosenberg, A, Alatary, SD, Peterson, AF. Safety and efficacy of the antiseptic Chlorhexidine gluconate. Surg Gynecol Obstet 1976;143:789792.Google Scholar
10.Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Blom, DW, Weinstein, RA. 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.Google Scholar
11.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.CrossRefGoogle ScholarPubMed
12.What the experts say. Chlorhexidine gluconate (CHG) skin preps: benefits and compatibility. Sage Products, Inc. Available at: http://www.sageproducts.com/education/pdf/20785.pdf. Accessed November 1,2005.Google Scholar
13.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.Google Scholar
14.Bekeris, LG, Tworek, JA, Walsh, MK, Valenstein, PN. Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Arch Pathol Lab Med 2005;129:12221225.CrossRefGoogle ScholarPubMed
15.Lin, MY, Hota, B, Woeltje, KJ, et al.Multicenter comparison of electronic algorithms for catheter-related bloodstream infection surveillance in intensive care units. In: Program and abstracts of the 18th Annual Meeting of the Society for Healthcare Epidemiology of America; Orlando, FL; April 5-8, 2008:97. Abstract 346.Google Scholar
16.Odore, R, Colombatti Valle, V, Re, G. Efficacy of Chlorhexidine against some strains of cultured and clinically isolated microorganisms. Vet Res Commun 2000;24:229238.CrossRefGoogle ScholarPubMed
17.Maki, D. Prospective evaluation of 6 preoperative cutaneous antisepsis regimens for prevention of surgical site infection. In: Program and abstracts of the 16th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; Chicago, IL; March 18-21,2006:104. Abstract 137.Google Scholar
18.Bleasdale, S, Hayes, R, Trick, WE, et al.Does Chlorhexidine gluconate (CHG) bathing of medical intensive care unit (MICU) patients prevent bloodstream infections (BSIs)? In: Proceedings of the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC; American Society for Microbiology; 2005:226. Abstract LB2-28.Google Scholar
19.Popovich, KJ, Hota, B, Pur, S, Hayes, R, Weinstein, RA, Hayden, MK. Effectiveness of routine cleansing with Chlorhexidine gluconate for infection control in intensive care units. In: Program and abstracts of the 18th Annual Meeting of the Society for Healthcare Epidemiology of America; Orlando, FL; April 5-8, 2008:93. Abstract 336.Google Scholar
20.Harris, AD, Bradham, DD, Baumgarten, M, Zuckerman, IH, Fink, JC, Per-encevich, EN. The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004;38:15861591.Google Scholar
21.Milstone, AM, Passaretti, CL, Perl, TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008;46:274281.Google Scholar