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Boyce JM. Best products for skin antisepsis. Am J Infect Control 2023; 51:A58-A63. [PMID: 37890954 DOI: 10.1016/j.ajic.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Skin antiseptics are used for several purposes before surgical procedures, for bathing high-risk patients as a means of reducing central line-associated infections and other health care associated infections. METHODS A PubMed search was performed to update the evidence on skin antiseptic products and practices. RESULTS Current guidelines for prevention of surgical site infections (SSIs) recommend preoperative baths or showers with a plain or antimicrobial soap prior to surgery, but do not make recommendations on the timing of baths, the total number of baths needed, or about the use of chlorhexidine gluconate (CGH)-impregnated cloths. Randomized controlled trials have demonstrated that pre-operative surgical hand antisepsis using an antimicrobial soap or alcohol-based hand rub yields similar SSI rates. Other studies have reported that using an alcohol-based hand rub caused less skin irritation, was easier to use, and required shorter scrub times than using antimicrobial soap. Current SSI prevention guidelines recommend using an alcohol-containing antiseptic for surgical site infection. Commonly used products contain isopropanol combined with either CHG or with povidone-iodine. Surgical site preparation protocols for shoulder surgery in men may need to include coverage for anaerobes. Several studies suggest the need to monitor and improve surgical site preparation techniques. Daily bathing of intensive care unit (ICU) patients with a CHG-containing soap reduces the incidence of central line-associated bloodstream infections (CLABSIs). Evidence for a similar effect in non-ICU patients is mixed. Despite widespread CHG bathing of ICU patients, numerous barriers to its effective implementation exist. Measuring CHG levels on the skin is useful for identifying gaps in coverage and suboptimal skin concentrations. Using alcohol-based products with at least 2% CHG for skin preparation prior to central line insertion reduces CLABSIs. CONCLUSIONS Progress has been made on skin antisepsis products and protocols, but improvements in technique are still needed.
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Denkel LA, Schwab F, Clausmeyer J, Behnke M, Golembus J, Wolke S, Gastmeier P, Geffers C. Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trial. Antimicrob Resist Infect Control 2023; 12:55. [PMID: 37270604 DOI: 10.1186/s13756-023-01260-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/29/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUNDS Antiseptic bathing did not reduce central-line (CL) associated bloodstream infection (CLABSI) rates in intensive care units (ICU) according to a recent cluster randomised controlled trial (cRCT). However, this analysis did not consider baseline infection rates. Our post-hoc analysis of this cRCT aimed to use a before-after comparison to examine the effect of daily bathing with chlorhexidine, octenidine or water and soap (control) on ICU-attributable CLABSI rates. METHODS A post-hoc analysis of a multi-center cRCT was done. ICUs that did not yet perform routine antiseptic bathing were randomly assigned to one of three study groups applying daily bathing with 2% chlorhexidine-impregnated cloths, 0.08% octenidine wash mitts or water and soap (control) for 12 months. Baseline data was assessed 12 months before the intervention started when all ICUs routinely used water and soap. Poisson regression and generalised estimating equation models were applied to identify changes of CLABSI rates per 1000 CL days between intervention and baseline periods in each study group. RESULTS The cRCT was conducted in 72 ICUs (24 per study group) including 76,139 patients in the baseline and 76,815 patients in the intervention period. In the chlorhexidine group, incidence density of CLABSI was reduced from 1.48 to 0.90 CLABSI per 1000 CL days comparing baseline versus intervention period (P = 0.0085). No reduction was observed in the octenidine group (1.26 versus 1.47 CLABSI per 1000 CL days, P = 0.8735) and the control group (1.20 versus 1.17, P = 0.3298). Adjusted incidence rate ratios (intervention versus baseline) were 0.63 (95%CI 0.46-0.87, P = 0.0172) in the chlorhexidine, 1.17 (95% CI 0.79-1.72, P = 0.5111) in the octenidine and 0.98 (95% CI 0.60-1.58, P = 0.9190) in the control group. Chlorhexidine bathing reduced CLABSI with gram-positive bacteria, mainly coagulase-negative staphylococci (CoNS). CONCLUSIONS In this post-hoc analysis of a cRCT, the application of 2% chlorhexidine-impregnated cloths reduced ICU-attributable CLABSI. This preventive effect of chlorhexidine was restricted to CLABSI caused by gram-positive pathogens (CoNS). In contrast, 0.08% octenidine wash mitts did not reduce CLABSI rates in ICUs. Trial registration Registration number DRKS00010475, registration date August 18, 2016.
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Affiliation(s)
- Luisa A Denkel
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany.
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jörg Clausmeyer
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jennifer Golembus
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Solvy Wolke
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Christine Geffers
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Hindenburgdamm 27, 12203, Berlin, Germany
- National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2022; 43:553-569. [PMID: 35437133 PMCID: PMC9096710 DOI: 10.1017/ice.2022.87] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Coia JE, Wilson JA, Bak A, Marsden GL, Shimonovich M, Loveday HP, Humphreys H, Wigglesworth N, Demirjian A, Brooks J, Butcher L, Price JR, Ritchie L, Newsholme W, Enoch DA, Bostock J, Cann M, Wilson APR. Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2021; 118S:S1-S39. [PMID: 34757174 DOI: 10.1016/j.jhin.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Affiliation(s)
- J E Coia
- Department of Clinical Microbiology, Hospital South West Jutland, Esbjerg, Denmark; Department of Regional Health Research IRS, University of Southern Denmark, Denmark; Healthcare Infection Society, London, UK
| | - J A Wilson
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - A Bak
- Healthcare Infection Society, London, UK.
| | | | - M Shimonovich
- Healthcare Infection Society, London, UK; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - H P Loveday
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - H Humphreys
- Healthcare Infection Society, London, UK; Department of Clinical Microbiology, The Royal College of Surgeons, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - N Wigglesworth
- Infection Prevention Society, Seafield, UK; East Kent Hospitals University, NHS Foundation Trust, Canterbury, UK
| | - A Demirjian
- Healthcare-associated Infection and Antimicrobial Resistance, Public Health England, London, UK; Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J Brooks
- Infection Prevention Society, Seafield, UK; University Hospital Southampton NHS Foundation Trust, UK
| | - L Butcher
- Infection Prevention Society, Seafield, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - J R Price
- Healthcare Infection Society, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - L Ritchie
- Healthcare Infection Society, London, UK; NHS England and NHS Improvement, London, UK
| | - W Newsholme
- Healthcare Infection Society, London, UK; Guy's and St Thomas' NHS Foundation Trust, UK
| | - D A Enoch
- Healthcare Infection Society, London, UK; Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke's Hospital, Cambridge, UK
| | | | - M Cann
- Lay Member, UK; MRSA Action UK, Preston, UK
| | - A P R Wilson
- Healthcare Infection Society, London, UK; University College London Hospitals NHS Foundation Trust, UK.
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Zheng Y, Xu N, Pang J, Han H, Yang H, Qin W, Zhang H, Li W, Wang H, Chen Y. Colonization With Extensively Drug-Resistant Acinetobacter baumannii and Prognosis in Critically Ill Patients: An Observational Cohort Study. Front Med (Lausanne) 2021; 8:667776. [PMID: 33996866 PMCID: PMC8119758 DOI: 10.3389/fmed.2021.667776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Acinetobacter baumannii is one of the most frequently isolated opportunistic pathogens in intensive care units (ICUs). Extensively drug-resistant A. baumannii (XDR-AB) strains lack susceptibility to almost all antibiotics and pose a heavy burden on healthcare institutions. In this study, we evaluated the impact of XDR-AB colonization on both the short-term and long-term survival of critically ill patients. Methods: We prospectively enrolled patients from two adult ICUs in Qilu Hospital of Shandong University from March 2018 through December 2018. Using nasopharyngeal and perirectal swabs, we evaluated the presence of XDR-AB colonization. Participants were followed up for 6 months. The primary endpoints were 28-day and 6-month mortality after ICU admission. The overall survival rate was estimated by the Kaplan-Meier method. We identified risk factors associated with 28-day and 6-month mortality using the logistic regression model and a time-dependent Cox regression model, respectively. Results: Out of 431 patients, 77 were colonized with XDR-AB. Based on the Kaplan-Meier curve results, the overall survival before 28 days did not differ by colonization status; however, a significantly lower overall survival rate was obtained at 6 months in colonized patients. Univariate and multivariate analysis results confirmed that XDR-AB colonization was not associated with 28-day mortality, but was an independent risk factor of lower overall survival at 6 months (HR = 1.749, 95% CI = 1.174-2.608). Conclusions: XDR-AB colonization has no effect on short-term overall survival, but is associated with lower long-term overall survival in critically ill patients.
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Affiliation(s)
- Yue Zheng
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Nana Xu
- Cardiosurgery Care Unit, Department of Cardiosurgery, Qilu Hospital of Shandong University, Jinan, China
| | - Jiaojiao Pang
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Han
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Hongna Yang
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Weidong Qin
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Hui Zhang
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Wei Li
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, China
| | - Hao Wang
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Department of Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
- Department of Pharmacology, School of Basic Medical Sciences, Shandong University, Jinan, China
| | - Yuguo Chen
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, Jinan, China
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Tien KL, Sheng WH, Shieh SC, Hung YP, Tien HF, Chen YH, Chien LJ, Wang JT, Fang CT, Chen YC. Chlorhexidine Bathing to Prevent Central Line-Associated Bloodstream Infections in Hematology Units: A Prospective, Controlled Cohort Study. Clin Infect Dis 2021; 71:556-563. [PMID: 31504341 DOI: 10.1093/cid/ciz874] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 08/30/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chlorhexidine (CHG) bathing decreases the incidence of bloodstream infections in intensive care units, but its effect has been understudied in patients with hematological malignancies in noncritical care units. METHODS Adults with hematological malignancies hospitalized for cytotoxic chemotherapy in noncritical care units were offered daily 2% CHG bathing. We compared outcomes of patients who chose CHG bathing (CHG group) with outcomes of those who did not choose CHG bathing (usual-care group). The primary outcome was gram-positive cocci-related, skin flora-related, or central line-associated bloodstream infection. The negative control outcome was gut-origin bacteremia. RESULTS The CHG group (n = 485) had a crude incidence rate of the primary outcome that was 60% lower than the rate for the usual-care group (n = 408; 3.4 vs 8.4 per 1000 patient-days, P = .02) but had a similar crude incidence rate of the negative control outcome (4.5 vs 3.2 per 1000 patient-days; P = .10). In multivariable analyses, CHG bathing was associated with a 60% decrease in the primary outcome (adjusted hazard ratio [HR], 0.4; P < .001). In contrast, CHG bathing had no effect on the negative control outcome (adjusted HR, 1.1; P = .781). CHG bathing was well tolerated by participants in the CHG group. CONCLUSIONS CHG bathing could be a highly effective approach for preventing gram-positive cocci-related, skin flora-related, or central line-associated bacteremia in patients with hematological malignancies who are hospitalized for cytotoxic chemotherapy in noncritical care units.
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Affiliation(s)
| | | | - Shiouh-Chu Shieh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Ping Hung
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Yi-Hsuan Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Li-Jung Chien
- Division of Infection Control and Biosafety, Centers for Disease Control, Taipei, Taiwan
| | - Jann-Tay Wang
- Center for Infection Control, Taipei, Taiwan.,Department of Internal Medicine, Taipei, Taiwan
| | - Chi-Tai Fang
- Department of Internal Medicine, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yee-Chun Chen
- Center for Infection Control, Taipei, Taiwan.,Department of Internal Medicine, Taipei, Taiwan
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ddcP, pstB, and excess D-lactate impact synergism between vancomycin and chlorhexidine against Enterococcus faecium 1,231,410. PLoS One 2021; 16:e0249631. [PMID: 33831063 PMCID: PMC8031426 DOI: 10.1371/journal.pone.0249631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/22/2021] [Indexed: 11/19/2022] Open
Abstract
Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens that cause life-threatening infections. To control hospital-associated infections, skin antisepsis and bathing utilizing chlorhexidine is recommended for VRE patients in acute care hospitals. Previously, we reported that exposure to inhibitory chlorhexidine levels induced the expression of vancomycin resistance genes in VanA-type Enterococcus faecium. However, vancomycin susceptibility actually increased for VanA-type E. faecium in the presence of chlorhexidine. Hence, a synergistic effect of the two antimicrobials was observed. In this study, we used multiple approaches to investigate the mechanism of synergism between chlorhexidine and vancomycin in the VanA-type VRE strain E. faecium 1,231,410. We generated clean deletions of 7 of 11 pbp, transpeptidase, and carboxypeptidase genes in this strain (ponA, pbpF, pbpZ, pbpA, ddcP, ldtfm, and vanY). Deletion of ddcP, encoding a membrane-bound carboxypeptidase, altered the synergism phenotype. Furthermore, using in vitro evolution, we isolated a spontaneous synergy escaper mutant and utilized whole genome sequencing to determine that a mutation in pstB, encoding an ATPase of phosphate-specific transporters, also altered synergism. Finally, addition of excess D-lactate, but not D-alanine, enhanced synergism to reduce vancomycin MIC levels. Overall, our work identified factors that alter chlorhexidine and vancomycin synergism in a model VanA-type VRE strain.
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Zerr DM, Milstone AM, Dvorak CC, Adler AL, Chen L, Villaluna D, Dang H, Qin X, Addetia A, Yu LC, Conway Keller M, Esbenshade AJ, August KJ, Fisher BT, Sung L. Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double-blinded randomized controlled trial from the Children's Oncology Group. Cancer 2021; 127:56-66. [PMID: 33079403 PMCID: PMC7820990 DOI: 10.1002/cncr.33271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND To the authors' knowledge, information regarding whether daily bathing with chlorhexidine gluconate (CHG) reduces central line-associated bloodstream infection (CLABSI) in pediatric oncology patients and those undergoing hematopoietic stem cell transplantation (HCT) is limited. METHODS In the current multicenter, randomized, double-blind, placebo-controlled trial, patients aged ≥2 months and <22 years with cancer or those undergoing allogeneic HCT were randomized 1:1 to once-daily bathing with 2% CHG-impregnated cloths or control cloths for 90 days. The primary outcome was CLABSI. Secondary endpoints included total positive blood cultures, acquisition of resistant organisms, and acquisition of cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration. RESULTS The study was stopped early because of poor accrual. Among the 177 enrolled patients, 174 were considered as evaluable (88 were randomized to the CHG group and 86 were randomized to the control group). The rate of CLABSI per 1000 central line days in the CHG group was 5.44 versus 3.10 in the control group (risk difference, 2.37; 95% confidence interval, 0.05-4.69 [P = .049]). Post hoc conditional power analysis demonstrated a 0.2% chance that the results would have favored CHG had the study fully enrolled. The rate of total positive blood cultures did not differ between groups (risk difference, 2.37; 95% confidence interval, -0.41 to 5.14 [P = .078]). The number of patients demonstrating the new acquisition of resistant organisms did not differ between groups (P = .54). Patients in the CHG group were found to be more likely to acquire cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration (P = .032). CONCLUSIONS The data from the current study do not support the use of routine CHG bathing in children with cancer or those undergoing allogeneic HCT.
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Affiliation(s)
- Danielle M. Zerr
- Seattle Children's Research InstituteSeattleWashington,Department of PediatricsUniversity of WashingtonSeattleWashington
| | - Aaron M. Milstone
- Department of PediatricsJohns Hopkins University School of MedicineBaltimoreMaryland
| | - Christopher C. Dvorak
- Division of Pediatric Allergy, Immunology, and Blood and Marrow TransplantationUniversity of California at San FranciscoSan FranciscoCalifornia
| | | | - Lu Chen
- Division of BiostatisticsCity of HopeDuarteCalifornia
| | | | - Ha Dang
- Department of Preventive MedicineUniversity of Southern CaliforniaLos AngelesCalifornia
| | - Xuan Qin
- Seattle Children's Research InstituteSeattleWashington
| | - Amin Addetia
- Seattle Children's Research InstituteSeattleWashington
| | - Lolie C. Yu
- Department of PediatricsChildren's HospitalLouisiana State University Health New OrleansNew OrleansLouisiana
| | - Mary Conway Keller
- Division of Hematology/OncologyConnecticut Children's Medical CenterHartfordConnecticut
| | - Adam J. Esbenshade
- Department of Pediatricsthe Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt‐Ingram Cancer Center, Vanderbilt University School of MedicineNashvilleTennessee
| | - Keith J. August
- Department of PediatricsChildren's Mercy HospitalKansas CityMissouri
| | - Brian T. Fisher
- Division of Pediatric Infectious DiseasesChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania,Department of Biostatistics, Epidemiology and InformaticsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Lillian Sung
- Division of Haematology/Oncology, Program in Child Health Evaluative SciencesThe Hospital for Sick ChildrenTorontoOntarioCanada
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9
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Use of a simple colorimetric assay to provide monitoring and feedback on adherence to chlorhexidine bathing protocols. Am J Infect Control 2020; 48:469-470. [PMID: 31864806 DOI: 10.1016/j.ajic.2019.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022]
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10
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Qing F, Liu C. Forecasting Single Disease Cost of Cataract Based on Multivariable Regression Analysis and Backpropagation Neural Network. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019880740. [PMID: 31617426 PMCID: PMC6796205 DOI: 10.1177/0046958019880740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In medical services, charge according to the disease is an important way to
promote the reform of pricing mechanism, control the unreasonable growth of
medical expenses, as well as reduce the burden on patients. Single disease cost
forecasting that both identify potential influencing or driving factors and
enable better proactive estimation of costs can guide the management and control
of medical costs. This study aimed to identify the factors that affect the
medical costs of single disease cataract and compare 2 regression models for
anticipating acceptable medical cost forecasts. For this purpose, 483 patients
with cataract surgery completed in West China Hospital from May 1, 2015, to
October 1, 2015, were selected from hospital information system. For cost
forecasting, multivariable regression analysis (MRA) and backpropagation neural
network (BPNN) were used. Analysis of data was performed with SPSS21.0 and
MATLAB2014a software. Total medical costs of patients with cataract (n = 483)
ranged from 2015.00 to 13 359.00 CNY, and the mean ± standard deviation is
6292.29 ± 2639.43 CNY. Factors influencing costs of cataract in the MRA include,
in importance order, intraocular lens (IOL) implantation (|r|:
0.805, P < .01), doctor level (|r|: 0.644,
P < .01), payment source (|r|: 0.554,
P < .01), admission status (|r|: 0.326,
P < .01), additional diagnosis (|r|:
0.260, P < .01), type of surgery (|r|:
0.127, P < .05), and type of anesthesia
(|r|: 0.126, P < .05). In terms of
forecasting performance, BPNN (average error: 2.81%) outperforms, yet is less
interpretable than MRA (average error: 5.79%). Both MRA and BPNN are technically
and economically feasible in generating medical costs of cataract. And some
insights on using results of the forecasting model in controlling and reducing
disease costs are obtained.
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Affiliation(s)
- Fang Qing
- Business School, Sichuan University, Chengdu, China
| | - Chuang Liu
- Business School, Sichuan University, Chengdu, China.,Logistics Engineering School, Chengdu Vocational & Technical College of Industry, China
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11
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Wiemken TL. Skin antiseptics in healthcare facilities: is a targeted approach necessary? BMC Public Health 2019; 19:1158. [PMID: 31438910 PMCID: PMC6705093 DOI: 10.1186/s12889-019-7507-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/15/2019] [Indexed: 12/01/2022] Open
Abstract
Background Skin antisepsis occurs in every healthcare environment. From basic hand hygiene, to antiseptic bathing and pre surgical care with alcohol/chlorhexidine, use of antimicrobial agents to reduce the skin microflora has skyrocketed in the past several years. Although used in hopes of reducing the likelihood of infection in patients, many products have been identified as the source of infection in several outbreaks, sometimes due to the nonsterile nature of the many readily available antiseptics. Body Intrinsic contamination of antiseptics during the manufacturing process is common. In fact, since the majority of these products are sold as nonsterile, they are allowed some level of microbial contamination based on the United States Pharmacopeia documents 61 and 62. Unfortunately, sometimes this contamination is with microorganisms resistant to the antiseptic and/or with those pathogenic to humans. In this scenario, healthcare-associated infections may occur, leaving the patient at higher risk of mortality and increasing costs of care substantially. Although antibiotic stewardship programs throughout the world suggest targeting use of antibiotics to limit resistance, few healthcare environments include other antimicrobial agents (such as antiseptics) in their programs. Conclusion Due to the potential for contamination with pathogenic organisms and the increased likelihood of selecting for resistant organisms with widespread use of broad-spectrum agents with non-specific mechanisms of action, a discussion around including skin antiseptics in stewardship programs is necessary, particularly those labeled as nonsterile. At minimum, debating the pros and cons of targeting use of daily antiseptic bathing in hospitalized patients should occur. Through mindfully incorporating any antimicrobial agent, sterile or not, into our repertoire of anti-infectives, we can save patient lives, reduce infection, and save costs.
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Affiliation(s)
- Timothy L Wiemken
- Center for Health Outcomes Research, Saint Louis University, 3545 Lafayette Ave, #411, St. Louis, MO, 63108, USA.
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12
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Matsumoto C, Nanke K, Furumura S, Arimatsu M, Fukuyama M, Maeda H. Effects of disposable bath and towel bath on the transition of resident skin bacteria, water content of the stratum corneum, and relaxation. Am J Infect Control 2019; 47:811-815. [PMID: 30639096 DOI: 10.1016/j.ajic.2018.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Bed bath in daily nursing care is crucial for cleaning and moisturizing patients' skin. The purpose of this study was to compare the effectiveness of cleaning and level of comfort of towel and disposable baths. The 2 methods were evaluated based on measurements of the transition of resident skin bacteria, stratum corneum water content, transepidermal water loss, and perceived relaxation levels. METHODS Twenty-six healthy women aged 65-90 years participated in this study and received disposable and towel baths. We measured 4 indicators before and after bathing. The participants' relaxation levels were measured by the Japanese adult version of the Profile of Mood States Second Edition short form. RESULTS Both disposable and towel baths significantly decreased resident skin bacteria. Disposable bath also significantly reduced Staphylococcus aureus and effectively maintained the water content of the stratum corneum. Furthermore, disposable bath was as effective as towel bath at contributing to participants' relaxation levels. CONCLUSIONS This study suggested that using a disposable bath for daily cleaning of patients' skin is more comfortable and effective than using a towel bath.
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Pallotto C, Fiorio M, De Angelis V, Ripoli A, Franciosini E, Quondam Girolamo L, Volpi F, Iorio P, Francisci D, Tascini C, Baldelli F. Daily bathing with 4% chlorhexidine gluconate in intensive care settings: a randomized controlled trial. Clin Microbiol Infect 2019; 25:705-710. [DOI: 10.1016/j.cmi.2018.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/21/2018] [Accepted: 09/16/2018] [Indexed: 10/28/2022]
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14
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Musuuza JS, Guru PK, O'Horo JC, Bongiorno CM, Korobkin MA, Gangnon RE, Safdar N. The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC Infect Dis 2019; 19:416. [PMID: 31088521 PMCID: PMC6518712 DOI: 10.1186/s12879-019-4002-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/17/2019] [Indexed: 01/14/2023] Open
Abstract
Background Chlorhexidine gluconate (CHG) bathing of hospitalized patients may have benefit in reducing hospital-acquired bloodstream infections (HABSIs). However, the magnitude of effect, implementation fidelity, and patient-centered outcomes are unclear. In this meta-analysis, we examined the effect of CHG bathing on prevention of HABSIs and assessed fidelity to implementation of this behavioral intervention. Methods We undertook a meta-analysis by searching Medline, EMBASE, CINAHL, Scopus, and Cochrane’s CENTRAL registry from database inception through January 4, 2019 without language restrictions. We included randomized controlled trials, cluster randomized trials and quasi-experimental studies that evaluated the effect of CHG bathing versus a non-CHG comparator for prevention of HABSIs in any adult healthcare setting. Studies of pediatric patients, of pre-surgical CHG use, or without a non-CHG comparison arm were excluded. Outcomes of this study were HABSIs, patient-centered outcomes, such as patient comfort during the bath, and implementation fidelity assessed through five elements: adherence, exposure or dose, quality of the delivery, participant responsiveness, and program differentiation. Three authors independently extracted data and assessed study quality; a random-effects model was used. Results We included 26 studies with 861,546 patient-days and 5259 HABSIs. CHG bathing markedly reduced the risk of HABSIs (IRR = 0.59, 95% confidence interval [CI]: 0.52–0.68). The effect of CHG bathing was consistent within subgroups: randomized (0.67, 95% CI: 0.53–0.85) vs. non-randomized studies (0.54, 95% CI: 0.44–0.65), bundled (0.66, 95% CI: 0.62–0.70) vs. non-bundled interventions (0.51, 95% CI: 0.39–0.68), CHG impregnated wipes (0.63, 95% CI: 0.55–0.73) vs. CHG solution (0.41, 95% CI: 0.26–0.64), and intensive care unit (ICU) (0.58, 95% CI: 0.49–0.68) vs. non-ICU settings (0.56, 95% CI: 0.38–0.83). Only three studies reported all five measures of fidelity, and ten studies did not report any patient-centered outcomes. Conclusions Patient bathing with CHG significantly reduced the incidence of HABSIs in both ICU and non-ICU settings. Many studies did not report fidelity to the intervention or patient-centered outcomes. For sustainability and replicability essential for effective implementation, fidelity assessment that goes beyond whether a patient received an intervention or not should be standard practice particularly for complex behavioral interventions such as CHG bathing. Trial registration Study registration with PROSPERO CRD42015032523. Electronic supplementary material The online version of this article (10.1186/s12879-019-4002-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jackson S Musuuza
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Pramod K Guru
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - John C O'Horo
- Division of Infectious Diseases and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Connie M Bongiorno
- Bio-Medical Library, University of Minnesota Libraries, Minneapolis, MN, USA
| | - Marc A Korobkin
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ronald E Gangnon
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA.,Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. .,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
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Weinstein RA. Clarification of errors in Abbas et al.'s conflict of interest narrative review. Intensive Care Med 2018; 45:128-129. [PMID: 30478621 DOI: 10.1007/s00134-018-5471-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Robert A Weinstein
- Chairman Emeritus, Department of Medicine, Cook County Health and Hospitals System, Rush University Medical Center, Chicago, Illinois, USA.
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Abbas M, Pires D, Peters A, Morel CM, Hurst S, Holmes A, Saito H, Allegranzi B, Lucet JC, Zingg W, Harbarth S, Pittet D. Conflicts of interest in infection prevention and control research: no smoke without fire. A narrative review. Intensive Care Med 2018; 44:1679-1690. [PMID: 30206643 DOI: 10.1007/s00134-018-5361-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/29/2018] [Indexed: 02/07/2023]
Abstract
Conflicts of interest (COIs) do occur in healthcare research, yet their impact on research in the field of infection prevention and control (IPC) is unknown. We conducted a narrative review aiming to identify examples of COIs in IPC research. In addition to well-known instances, we conducted PubMed and Google searches to identify and report case studies of COIs in IPC and antimicrobial resistance (AMR), which were chosen arbitrarily following consensus meetings, to illustrate different types of COIs. We also searched the Retraction Watch database and blog to systematically identify retracted IPC and/or infectious disease-related papers. Our review highlights COIs in academic research linked to ties between industry and physicians, journal editors, peer-reviewed journals' choice for publication, and guideline committees participants and authors. It explores how COIs can affect research and could be managed. We also present several selected case studies that involve (1) the chlorhexidine industry and how it has used marketing trials and key opinion leaders to promote off-label use of its products; (2) the copper industry and how reporting of its trials in IPC have furthered their agenda; (3) the influence of a company developing "closed infusion systems" for catheters and how this affects networks in low- and middle-income countries and guideline development; (4) potential perverse incentives hospitals may have in reporting healthcare-associated infection or AMR rates and how government intervention may restrict AMR research for fear of bad publicity and subsequent negative economic consequences. Finally, the analysis of reasons for the retraction of previously published papers highlights the fact that misconduct in research may have other motivations than financial gain, the most visible form of COIs. COIs occur in the field of research in general, and IPC and AMR are no exceptions. Their effects pervade all aspects of the research and publication processes. We believe that, in addition to improvements in management strategies of COIs, increased public funding should be available to decrease researchers' dependency on industry ties. Further research is needed on COIs and their management.
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Affiliation(s)
- Mohamed Abbas
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland.
| | - Daniela Pires
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland.,Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicine da Universidade de Lisboa, Lisbon, Portugal
| | - Alexandra Peters
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
| | - Chantal M Morel
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, University of Geneva Medical School, Geneva, Switzerland
| | - Alison Holmes
- Department of Infectious Diseases and the NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Hiroki Saito
- Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, 1211, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, 1211, Geneva, Switzerland
| | | | - Walter Zingg
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland
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Abstract
Invasive candida infections are the most important causes of nosocomial infections in intensive care units and in risky groups such as immunosuppressed patients. These infections lead to undesirable consequences such as increased morbidity and mortality in patients, prolongation of hospital stay, and increased hospital costs. In recent years, the incidence of non-albicans Candida spp.'s has increased. Unfortunately, some of these species are naturally resistant to first-line antifungals. In addition, biofilm formation on the central venous catheter and invasive devices may cause treatment failure. The age of the patients, co-morbid diseases, the units where they are treated, the antibiotics and antifungals that are used for the treatment, and invasive devices are risk factors for invasive candida infections. Some of these risk factors can be reduced by the behavior of health-care workers. The most important goal is to take precautions before the occurrence of invasive candida infections. Infection control measures to prevent hospital transmission of candida are very important. Compliance with hand hygiene before and after contact with the patient is the most important step to prevent the spreading of Candida spp. Observation of maximal barrier precautions during invasive catheterization is another important clause of this aim. Avoiding unnecessary invasive devices, antibiotics, and parenteral nutrition are also important to reduce the colonization of candida.
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Affiliation(s)
- Zeynep Ture
- a Department of Infectious Diseases and Clinical Microbiology , Health Ministry University of Kayseri Education and Research Hospital , Kayseri , Turkey
| | - Emine Alp
- b Department of Infectious Diseases and Clinical Microbiology, Infection Control Committee, Faculty of Medicine , Erciyes University , Kayseri , Turkey
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Silva AGD, Oliveira ACD. IMPACTO DA IMPLEMENTAÇÃO DOS BUNDLES NA REDUÇÃO DAS INFECÇÕES DA CORRENTE SANGUÍNEA: UMA REVISÃO INTEGRATIVA. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018003540016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: analisar as produções científicas nacionais e internacionais sobre o impacto dos bundles na prevenção de infecção da corrente sanguínea relacionada ao cateter venoso central em unidade de terapia intensiva adulta. Método: revisão integrativa de artigos publicados no Portal Capes, Biblioteca Virtual em Saúde, PubMed, Science Direct, Cochrane, CINAHL e SCOPUS, entre 2011 e 2016. Resultados: encontraram-se 16 artigos, 100% relacionados à implementação dos bundles para a inserção do cateter venoso central e 50% à manutenção deste dispositivo. O tempo de intervenção foi variado, bem como o número de medidas e o período analisado (inserção/manutenção do cateter). No entanto, a redução da infecção da corrente sanguínea relacionada ao dispositivo foi apontada em todos os estudos entre 26% e 100%. Conclusão: a adoção de bundle evidenciou um impacto positivo na redução da infecção. Todavia, não se observou uma relação direta entre o número de medidas descritas nos estudos ou o maior tempo de implementação e taxas mais altas de redução da infecção.
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Differential Effects of Chlorhexidine Skin Cleansing Methods on Residual Chlorhexidine Skin Concentrations and Bacterial Recovery. Infect Control Hosp Epidemiol 2018; 39:405-411. [PMID: 29493475 DOI: 10.1017/ice.2017.312] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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.
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Meißner A, Hasenclever D, Brosteanu O, Chaberny IF. EFFECT of daily antiseptic body wash with octenidine on nosocomial primary bacteraemia and nosocomial multidrug-resistant organisms in intensive care units: design of a multicentre, cluster-randomised, double-blind, cross-over study. BMJ Open 2017; 7:e016251. [PMID: 29122787 PMCID: PMC5695441 DOI: 10.1136/bmjopen-2017-016251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Nosocomial infections are serious complications that increase morbidity, mortality and costs and could potentially be avoidable. Antiseptic body wash is an approach to reduce dermal micro-organisms as potential pathogens on the skin. Large-scale trials with chlorhexidine as the antiseptic agent suggest a reduction of nosocomial infection rates. Octenidine is a promising alternative agent which could be more effective against Gram-negative organisms. We hypothesise that daily antiseptic body wash with octenidine reduces the risk of intensive care unit (ICU)-acquired primary bacteraemia and ICU-acquired multidrug-resistant organisms (MDRO) in a standard care setting. METHODS AND ANALYSIS EFFECT is a controlled, cluster-randomised, double-blind study. The experimental intervention consists in using octenidine-impregnated wash mitts for the daily routine washing procedure of the patients. This will be compared with using placebo wash mitts. Replacing existing washing methods is the only interference into clinical routine.Participating ICUs are randomised in an AB/BA cross-over design. There are two 15-month periods, each consisting of a 3-month wash-out period followed by a 12-month intervention and observation period. Randomisation determines only the sequence in which octenidine-impregnated or placebo wash mitts are used. ICUs are left unaware of what mitts packages they are using.The two coprimary endpoints are ICU-acquired primary bacteraemia and ICU-acquired MDRO. Endpoints are defined based on individual ward-movement history and microbiological test results taken from the hospital information systems without need for extra documentation. Data on clinical symptoms of infection are not collected. EFFECT aims at recruiting about 45 ICUs with about 225 000 patient-days per year. ETHICS AND DISSEMINATION The study was approved by the ethics committee of the University of Leipzig (number 340/16-ek) in November 2016. Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS-ID: DRKS00011282.
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Affiliation(s)
- Anne Meißner
- Institute of Hygiene/Hospital Epidemiology, Medical Faculty of the University of Leipzig, Leipzig, Saxony, Germany
| | - Dirk Hasenclever
- Institute for Medical Informatics, Statistics and Epidemiology, Medical Faculty of the University of Leipzig, Leipzig, Saxony, Germany
| | - Oana Brosteanu
- Clinical Trial Centre Leipzig, Medical Faculty of the University of Leipzig, Leipzig, SAxony, Germany
| | - Iris Freya Chaberny
- Institute of Hygiene/Hospital Epidemiology, Medical Faculty of the University of Leipzig, Leipzig, Saxony, Germany
- Institute of Hygiene/Hospital Epidemiology, Leipzig University Hospital, Leipzig, Saxony, Germany
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Implementation of daily chlorhexidine bathing to reduce colonization by multidrug-resistant organisms in a critical care unit. Am J Infect Control 2017; 45:1014-1017. [PMID: 28431846 DOI: 10.1016/j.ajic.2017.02.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 02/23/2017] [Accepted: 02/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Colonized patients are a reservoir for transmission of multidrug-resistant organisms (MDROs). Not many studies have examined the effectiveness of daily chlorhexidine gluconate (CHG) bathing under routine care conditions. We present a descriptive analysis of the trends of MDRO colonization following implementation of daily CHG bathing under routine clinical conditions in an intensive care unit (ICU). METHODS From May 2010-January 2011, we screened patients admitted to a 24-bed ICU for and methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and fluoroquinolone-resistant gram-negative bacilli (FQRGNB). We calculated and plotted monthly incidence and prevalence of colonization of these MDROs. RESULTS Prevalence decreased in the immediate aftermath of daily CHG bathing implementation and generally remained at that level throughout the observation period. We observed low rates of incidence of MDRO colonization with VRE>FQRGNB>MRSA. Monthly prevalence of colonization and incidence for the composite of MRSA, VRE, and/or FQRGNB was 1.9%-27.9% and 0-1.1/100 patient-days, respectively. CONCLUSIONS Following the implementation of daily CHG bathing, the incidence of MDROs remained low and constant over time, whereas the prevalence decreased immediately after the implementation.
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Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial. Crit Care Med 2017; 44:1822-32. [PMID: 27428384 DOI: 10.1097/ccm.0000000000001820] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To test the hypothesis that compared with daily soap and water bathing, 2% chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients. DESIGN This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded. SETTING Twenty-four-bed surgical ICU at a quaternary academic medical center. PATIENTS Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included. INTERVENTIONS Patients were randomized to bathing with 2% chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm). MEASUREMENTS AND MAIN RESULTS The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95% CI, 0.309-0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0% (95% CI, 1.5-16.4%; p = 0.019). Incidences of adverse skin occurrences were similar (18.9% soap and water vs 18.6% chlorhexidine; p = 0.95). CONCLUSIONS Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.
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Carbapenem-Resistant Enterobacteriaceae: A Strategic Roadmap for Infection Control. Infect Control Hosp Epidemiol 2017; 38:580-594. [PMID: 28294079 DOI: 10.1017/ice.2017.42] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The incidence of carbapenem-resistant Enterobacteriaceae (CRE) has increased worldwide with great regional variability. Infections caused by these organisms are associated with crude mortality rates of up to 70%. The spread of CRE in healthcare settings is both an important medical problem and a major global public health threat. All countries are at risk of falling victim to the emergence of CRE; therefore, a preparedness plan is required to avoid the catastrophic natural course of this epidemic. Proactive and adequate preventive measures locally, regionally, and nationally are required to contain the spread of these bacteria. The keys to success in preventing the establishment of CRE endemicity in a region are early detection through targeted laboratory protocols and containment of spread through comprehensive infection control measures. This guideline provides a strategic roadmap for infection control measures based on the best available evidence and expert opinion, to enable preparation of a multifaceted preparedness plan to abort epidemics of CRE. Infect Control Hosp Epidemiol 2017;38:580-594.
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Reduction in hospital-associated methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus with daily chlorhexidine gluconate bathing for medical inpatients. Am J Infect Control 2017; 45:255-259. [PMID: 27938986 DOI: 10.1016/j.ajic.2016.09.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/03/2016] [Accepted: 09/06/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Daily bathing with chlorhexidine gluconate (CHG) is increasingly used in intensive care units to prevent hospital-associated infections, but limited evidence exists for noncritical care settings. METHODS A prospective crossover study was conducted on 4 medical inpatient units in an urban, academic Canadian hospital from May 1, 2014-August 10, 2015. Intervention units used CHG over a 7-month period, including a 1-month wash-in phase, while control units used nonmedicated soap and water bathing. Rates of hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization or infection were the primary end point. Hospital-associated S. aureus were investigated for CHG resistance with a qacA/B and smr polymerase chain reaction (PCR) and agar dilution. RESULTS Compliance with daily CHG bathing was 58%. Hospital-associated MRSA and VRE was decreased by 55% (5.1 vs 11.4 cases per 10,000 inpatient days, P = .04) and 36% (23.2 vs 36.0 cases per 10,000 inpatient days, P = .03), respectively, compared with control cohorts. There was no significant difference in rates of hospital-associated Clostridium difficile. Chlorhexidine resistance testing identified 1 isolate with an elevated minimum inhibitory concentration (8 µg/mL), but it was PCR negative. CONCLUSIONS This prospective pragmatic study to assess daily bathing for CHG on inpatient medical units was effective in reducing hospital-associated MRSA and VRE. A critical component of CHG bathing on medical units is sustained and appropriate application, which can be a challenge to accurately assess and needs to be considered before systematic implementation.
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Wang EW, Layon AJ. Chlorhexidine gluconate use to prevent hospital acquired infections-a useful tool, not a panacea. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:14. [PMID: 28164099 DOI: 10.21037/atm.2017.01.01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Elizabeth Wenqian Wang
- Department of Hospital Medicine, The Medicine Institute, The Geisinger Health System, Danville, PA 17822-2037, USA
| | - A Joseph Layon
- Department of Critical Care Medicine, The Medicine Institute, The Geisinger Health System, Danville, PA 17822-2037, USA
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Popovich KJ. Another look at CHG bathing in a surgical intensive care unit. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:13. [PMID: 28164098 DOI: 10.21037/atm.2016.12.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kyle J Popovich
- Rush University Medical Center, Stroger Hospital of Cook County, Chicago, Illinois, USA
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Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand. Infect Control Hosp Epidemiol 2016; 37:245-53. [PMID: 26894621 DOI: 10.1017/ice.2015.285] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the effectiveness of daily bathing with 2% chlorhexidine-impregnated washcloths in preventing multidrug-resistant (MDR) gram-positive bacterial colonization and bloodstream infection. METHODS A randomized, open-label controlled trial was conducted in 4 medical intensive care units (ICUs) in Thailand from December 2013 to January 2015. Patients were randomized to receive cleansing with non-antimicrobial soap (control group) or 2% chlorhexidine-impregnated washcloths used to wipe the patient's body once daily (chlorhexidine group). Swabs were taken from nares, axilla, antecubital, groin, and perianal areas on admission and on day 3, 5, 7, and 14. The 5 outcomes were (1) favorable events ( all samples negative throughout ICU admission, or initially positive samples with subsequent negative samples); (2) MDR bacteria colonization-free time; (3) hospital-acquired infection; (4) length of ICU and hospital stay; (5) adverse skin reactions. RESULTS A total of 481 patients were randomly assigned to the control group (241) or the chlorhexidine group (240). Favorable events at day 14 were observed in 34.8% of patients in the control group and 28.6% in the chlorhexidine group (P=.79). Median MDR bacteria colonization-free times were 5 days in both groups. The incidence rate of hospital-acquired infection and the length of the ICU and hospital stay did not differ significantly between groups. The incidence of adverse skin reactions in the chlorhexidine group was 2.5%. CONCLUSION The effectiveness of 2% chlorhexidine-impregnated washcloths for the prevention of MDR gram-negative bacteria colonization and hospital-acquired infection in adult patients in ICU was not proven. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01989416.
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Huang HP, Chen B, Wang HY, He M. The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units. Korean J Intern Med 2016; 31:1159-1170. [PMID: 27048258 PMCID: PMC5094930 DOI: 10.3904/kjim.2015.240] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/23/2015] [Accepted: 09/06/2015] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Healthcare-associated infections (HAIs) in critically ill patients with prolonged length of hospital stay and increased medical costs. The aim of this study is to assess whether daily chlorhexidine gluconate (CHG) bathing will significantly reduce the rates of HAIs in adult intensive care units (ICUs). METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched until December 31, 2014 to identify relevant studies. Two authors independently reviewed and extracted data from included studies. All data was analyzed by Review Manager version 5.3. RESULTS Fifteen studies including three randomized controlled trials and 12 quasi-experimental studies were available in this study. The outcomes showed that daily CHG bathing were associated with significant reduction in the rates of primary outcomes: catheter-related bloodstream infection (risk ratio [RR], 0.44; 95% confidence interval [CI], 0.32 to 0.63; p < 0.00001), catheter-associated urinary tract infection (RR, 0.68; 95% CI, 0.52 to 0.88; p = 0.004), ventilator-associated pneumonia (RR, 0.73; 95% CI, 0.57 to 0.93; p = 0.01), acquisition of methicillin-resistant Staphylococcus aureus (RR, 0.78; 95% CI, 0.68 to 0.91; p = 0.001) and vancomycin-resistant Enterococcus (RR, 0.56; 95% CI, 0.31 to 0.99; p = 0.05). CONCLUSIONS Our study suggests that the use of daily CHG bathing can significantly prevent HAIs in ICUs. However, more well-designed studies are needed to confirm these findings.
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Affiliation(s)
- Hua-ping Huang
- Nursing Administration, Mianyang Central Hospital, Mianyang, China
- Correspondence to Hua-ping Huang, R.N. Nursing Administration, Mianyang Central Hospital, No. 12, Changjia Alley, Jingzhong Street, Fucheng District, Mianyang 621000, China Tel: +86-816-223-9671 Fax: +86-816-222-2566 E-mail:
| | - Bin Chen
- Intensive Care Unit, Mianyang Central Hospital, Mianyang, China
| | - Hai-Yan Wang
- Nursing Administration, Mianyang Central Hospital, Mianyang, China
| | - Me He
- Nursing Administration, Mianyang Central Hospital, Mianyang, China
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Abboud C, de Souza E, Zandonadi E, Borges L, Miglioli L, Monaco F, Barbosa V, Cortez D, Bianco A, Braz A, Monteiro J. Carbapenem-resistant Enterobacteriaceae on a cardiac surgery intensive care unit: successful measures for infection control. J Hosp Infect 2016; 94:60-4. [DOI: 10.1016/j.jhin.2016.06.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/13/2016] [Indexed: 11/30/2022]
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Lai NM, Lai NA, O'Riordan E, Chaiyakunapruk N, Taylor JE, Tan K. Skin antisepsis for reducing central venous catheter-related infections. Cochrane Database Syst Rev 2016; 7:CD010140. [PMID: 27410189 PMCID: PMC6457952 DOI: 10.1002/14651858.cd010140.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The central venous catheter (CVC) is a device used for many functions, including monitoring haemodynamic indicators and administering intravenous medications, fluids, blood products and parenteral nutrition. However, as a foreign object, it is susceptible to colonisation by micro-organisms, which may lead to catheter-related blood stream infection (BSI) and in turn, increased mortality, morbidities and health care costs. OBJECTIVES To assess the effects of skin antisepsis as part of CVC care for reducing catheter-related BSIs, catheter colonisation, and patient mortality and morbidities. SEARCH METHODS In May 2016 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations and Epub Ahead of Print); Ovid EMBASE and EBSCO CINAHL Plus. We also searched clinical trial registries for ongoing and unpublished studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) that assessed any type of skin antiseptic agent used either alone or in combination, compared with one or more other skin antiseptic agent(s), placebo or no skin antisepsis in patients with a CVC in place. DATA COLLECTION AND ANALYSIS Two authors independently assessed the studies for their eligibility, extracted data and assessed risk of bias. We expressed our results in terms of risk ratio (RR), absolute risk reduction (ARR) and number need to treat for an additional beneficial outcome (NNTB) for dichotomous data, and mean difference (MD) for continuous data, with 95% confidence intervals (CIs). MAIN RESULTS Thirteen studies were eligible for inclusion, but only 12 studies contributed data, with a total of 3446 CVCs assessed. The total number of participants enrolled was unclear as some studies did not provide such information. The participants were mainly adults admitted to intensive care units, haematology oncology units or general wards. Most studies assessed skin antisepsis prior to insertion and regularly thereafter during the in-dwelling period of the CVC, ranging from every 24 h to every 72 h. The methodological quality of the included studies was mixed due to wide variation in their risk of bias. Most trials did not adequately blind the participants or personnel, and four of the 12 studies had a high risk of bias for incomplete outcome data.Three studies compared different antisepsis regimens with no antisepsis. There was no clear evidence of a difference in all outcomes examined, including catheter-related BSI, septicaemia, catheter colonisation and number of patients who required systemic antibiotics for any of the three comparisons involving three different antisepsis regimens (aqueous povidone-iodine, aqueous chlorhexidine and alcohol compared with no skin antisepsis). However, there were great uncertainties in all estimates due to underpowered analyses and the overall very low quality of evidence presented.There were multiple head-to-head comparisons between different skin antiseptic agents, with different combinations of active substance and base solutions. The most frequent comparison was chlorhexidine solution versus povidone-iodine solution (any base). There was very low quality evidence (downgraded for risk of bias and imprecision) that chlorhexidine may reduce catheter-related BSI compared with povidone-iodine (RR of 0.64, 95% CI 0.41 to 0.99; ARR 2.30%, 95% CI 0.06 to 3.70%). This evidence came from four studies involving 1436 catheters. None of the individual subgroup comparisons of aqueous chlorhexidine versus aqueous povidone-iodine, alcoholic chlorhexidine versus aqueous povidone-iodine and alcoholic chlorhexidine versus alcoholic povidone-iodine showed clear differences for catheter-related BSI or mortality (and were generally underpowered). Mortality was only reported in a single study.There was very low quality evidence that skin antisepsis with chlorhexidine may also reduce catheter colonisation relative to povidone-iodine (RR of 0.68, 95% CI 0.56 to 0.84; ARR 8%, 95% CI 3% to 12%; ; five studies, 1533 catheters, downgraded for risk of bias, indirectness and inconsistency).Evaluations of other skin antiseptic agents were generally in single, small studies, many of which did not report the primary outcome of catheter-related BSI. Trials also poorly reported other outcomes, such as skin infections and adverse events. AUTHORS' CONCLUSIONS It is not clear whether cleaning the skin around CVC insertion sites with antiseptic reduces catheter related blood stream infection compared with no skin cleansing. Skin cleansing with chlorhexidine solution may reduce rates of CRBSI and catheter colonisation compared with cleaning with povidone iodine. These results are based on very low quality evidence, which means the true effects may be very different. Moreover these results may be influenced by the nature of the antiseptic solution (i.e. aqueous or alcohol-based). Further RCTs are needed to assess the effectiveness and safety of different skin antisepsis regimens in CVC care; these should measure and report critical clinical outcomes such as sepsis, catheter-related BSI and mortality.
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Affiliation(s)
- Nai Ming Lai
- Taylor's UniversitySchool of MedicineSubang JayaMalaysia
- Monash University MalaysiaSchool of PharmacySelangorMalaysia
| | - Nai An Lai
- Queen Elizabeth II Jubilee HospitalIntensive Care UnitCnr Troughton and Kessels RoadsCoopers PlainsQueenslandAustralia4108
| | - Elizabeth O'Riordan
- The University of Sydney and The Children's Hospital at WestmeadFaculty of Nursing and MidwiferySydneyNew South WalesAustralia2006
| | - Nathorn Chaiyakunapruk
- Monash University MalaysiaSchool of PharmacySelangorMalaysia
- Faculty of Pharmaceutical SciencesCenter of Pharmaceutical Outcomes Research, Department of Pharmacy PracticeNaresuan UniversityPhitsanulokThailand65000
- The University of QueenslandSchool of Population HealthBrisbaneQueenslandAustralia
| | - Jacqueline E Taylor
- Monash Medical Centre/Monash UniversityMonash Newborn246 Clayton RoadClaytonVictoriaAustralia3168
| | - Kenneth Tan
- Monash UniversityDepartment of Paediatrics246 Clayton RoadClaytonMelbourneVictoriaAustraliaVIC 3168
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Raulji CM, Clay K, Velasco C, Yu LC. Daily Bathing with Chlorhexidine and Its Effects on Nosocomial Infection Rates in Pediatric Oncology Patients. Pediatr Hematol Oncol 2016; 32:315-21. [PMID: 25918820 DOI: 10.3109/08880018.2015.1013588] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Infections remain a serious complication in pediatric oncology patients. To determine if daily bathing with Chlorhexidine gluconate can decrease the rate of nosocomial infection in pediatric oncology patients, we reviewed rates of infections in pediatric oncology patients over a 14-month span. Intervention group received daily bath with Chlorhexidine, while the control group did not receive daily bath. The results showed that daily bath with antiseptic chlorhexidine as daily prophylactic antiseptic topical wash leads to decreased infection density amongst the pediatric oncology patients, especially in patients older than 12 years of age. Furthermore, daily chlorhexidine bathing significantly reduced the rate of hospital acquired infection in patients older than 12 years of age. The findings of this study suggest that daily bathing with chlorhexidine may be an effective measure of reducing nosocomial infection in pediatric oncology patients.
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Affiliation(s)
- Chittalsinh M Raulji
- Pediatrics-Division of Pediatric Hematology Oncology, Louisiana State University/Children's Hospital of New Orleans , New Orleans, Louisiana , USA
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Using a Systems Engineering Initiative for Patient Safety to Evaluate a Hospital-wide Daily Chlorhexidine Bathing Intervention. J Nurs Care Qual 2016; 30:337-44. [PMID: 26035708 DOI: 10.1097/ncq.0000000000000129] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We undertook a systems engineering approach to evaluate housewide implementation of daily chlorhexidine bathing. We performed direct observations of the bathing process and conducted provider and patient surveys. The main outcome was compliance with bathing using a checklist. Fifty-seven percent of baths had full compliance with the chlorhexidine bathing protocol. Additional time was the main barrier. Institutions undertaking daily chlorhexidine bathing should perform a rigorous assessment of implementation to optimize the benefits of this intervention.
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Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016. [DOI: 10.1017/s0899823x00193870] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S108-32. [DOI: 10.1017/s0899823x00193882] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistantStaphylococcus aureus(MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: A review of the literature. Am J Infect Control 2016; 44:e17-21. [PMID: 27131130 DOI: 10.1016/j.ajic.2016.02.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/25/2016] [Indexed: 12/17/2022]
Abstract
Chlorhexidine bathing is effective in reducing levels of pathogens on skin. In this review, we examine the evidence that chlorhexidine bathing can prevent colonization and infection with health care-associated pathogens and reduce dissemination to the environment and the hands of personnel. The importance of education and monitoring of compliance with bathing procedures is emphasized in order to optimize chlorhexidine bathing in clinical practice.
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Kim HY, Lee WK, Na S, Roh YH, Shin CS, Kim J. The effects of chlorhexidine gluconate bathing on health care–associated infection in intensive care units: A meta-analysis. J Crit Care 2016; 32:126-37. [DOI: 10.1016/j.jcrc.2015.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/29/2015] [Accepted: 11/14/2015] [Indexed: 12/11/2022]
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Petlin A, Schallom M, Prentice D, Sona C, Mantia P, McMullen K, Landholt C. Chlorhexidine gluconate bathing to reduce methicillin-resistant Staphylococcus aureus acquisition. Crit Care Nurse 2016; 34:17-25; quiz 26. [PMID: 25274761 DOI: 10.4037/ccn2014943] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism causing substantial morbidity and mortality in intensive care units. Chlorhexidine gluconate, a topical antiseptic solution, is effective against a wide spectrum of gram-positive and gram-negative bacteria, including MRSA. Objectives To examine the impact of a bathing protocol using chlorhexidine gluconate and bath basin management on MRSA acquisition in 5 adult intensive care units and to examine the cost differences between chlorhexidine bathing by using the bath-basin method versus using prepackaged chlorhexidine-impregnated washcloths. METHODS The protocol used a 4-oz bottle of 4% chlorhexidine gluconate soap in a bath basin of warm water. Patients in 3 intensive care units underwent active surveillance for MRSA acquisition; patients in 2 other units were monitored for a new positive culture for MRSA at any site 48 hours after admission. RESULTS Before the protocol, 132 patients acquired MRSA in 34333 patient days (rate ratio, 3.84). Afterwards, 109 patients acquired MRSA in 41376 patient days (rate ratio, 2.63). The rate ratio difference is 1.46 (95% CI, 1.12-1.90; P = .003). The chlorhexidine soap and bath basin method cost $3.18 as compared with $5.52 for chlorhexidine-impregnated wipes (74% higher). CONCLUSIONS The chlorhexidine bathing protocol is easy to implement, cost-effective, and led to decreased unit-acquired MRSA rates in a variety of adult intensive care units.
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Affiliation(s)
- Ann Petlin
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.
| | - Marilyn Schallom
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Donna Prentice
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Carrie Sona
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Paula Mantia
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Kathleen McMullen
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Cassandra Landholt
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
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Grigonis AM, Dawson AM, Burkett M, Dylag A, Sears M, Helber B, Snyder LK. Use of a Central Catheter Maintenance Bundle in Long-Term Acute Care Hospitals. Am J Crit Care 2016; 25:165-72. [PMID: 26932919 DOI: 10.4037/ajcc2016894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Evidence-based guidelines have resulted in decreases in bloodstream infections associated with central catheters (CLABSIs) in hospital intensive care units. However, relatively little is known about CLABSI incidence and prevention in long-term acute care hospitals (LTACHs). METHODS A central catheter maintenance bundle was implemented in 30 LTACHs, and compliance with the bundle was tracked for 6 months. CLABSI rates were monitored for 14 months before and 14 months after the bundle was implemented. RESULTS The pooled mean CLABSI rate (No. of infections per 1000 days with a central catheter) was 1.28 before the bundle and 0.96 after the bundle (repeated measures general linear model; F1,58 = 6.973; P = .01; partial η(2) = .11). From 14 months before to 14 months after the bundle was implemented, the mean number of CLABSIs per LTACH decreased by 4.5 (95% CI, 1.85-7.15). Time series modeling showed a significant decrease in the mean hospital CLABSI rate after the bundle was implemented (-0.511 CLABSI/1000 catheter days, SE = 0.050), indicating an immediate effect of the bundle. The mean hospital CLABSI rate was decreasing slightly before the bundle was implemented and continued to decrease at a reduced rate after the bundle was implemented. CONCLUSION The bundle resulted in a significant and sustained reduction in CLABSI rates in 30 LTACHs for 14 months. These results encourage the development and implementation of similar bundles as effective strategies for infection reduction in LTACHs.
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Affiliation(s)
- Antony M. Grigonis
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Amanda M. Dawson
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Mary Burkett
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Arthur Dylag
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Matthew Sears
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Betty Helber
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
| | - Lisa K. Snyder
- Antony M. Grigonis is vice president of quality improvement, Amanda M. Dawson is director of research, Betty Helber is director of inpatient education, and Lisa K. Snyder is chief quality officer at Select Medical, Mechanicsburg, Pennsylvania. Mary Burkett is assistant professor of nursing, Capital University, Columbus, Ohio. Arthur Dylag is conduct coordinator at University of California, Davis. Matthew Sears is patient experience data analyst at The George Washington University Hospital, Washington, DC
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Laboratory diagnosis, clinical management and infection control of the infections caused by extensively drug-resistant Gram-negative bacilli: a Chinese consensus statement. Clin Microbiol Infect 2015; 22 Suppl 1:S15-25. [PMID: 26627340 DOI: 10.1016/j.cmi.2015.11.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/06/2015] [Accepted: 11/06/2015] [Indexed: 01/31/2023]
Abstract
Extensively drug-resistant (XDR) Gram-negative bacilli (GNB) are defined as bacterial isolates susceptible to two or fewer antimicrobial categories. XDR-GNB mainly occur in Enterobacteriaceae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. The prevalence of XDR-GNB is on the rise in China and in other countries, and it poses a major public health threat as a result of the lack of adequate therapeutic options. A group of Chinese clinical experts, microbiologists and pharmacologists came together to discuss and draft a consensus on the laboratory diagnosis, clinical management and infection control of XDR-GNB infections. Lists of antimicrobial categories proposed for antimicrobial susceptibility testing were created according to documents from the Clinical Laboratory Standards Institute (CLSI), the European Committee on Antimicrobial Susceptibility Testing (EUCAST) and the United States Food and Drug Administration (FDA). Multiple risk factors of XDR-GNB infections are analyzed, with long-term exposure to extended-spectrum antimicrobials being the most important one. Combination therapeutic regimens are summarized for treatment of XDR-GNB infections caused by different bacteria based on limited clinical studies and/or laboratory data. Most frequently used antimicrobials used for the combination therapies include aminoglycosides, carbapenems, colistin, fosfomycin and tigecycline. Strict infection control measures including hand hygiene, contact isolation, active screening, environmental surface disinfections, decolonization and restrictive antibiotic stewardship are recommended to curb the XDR-GNB spread.
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Evaluating the Use of the Case Mix Index for Risk Adjustment of Healthcare-Associated Infection Data: An Illustration using Clostridium difficile Infection Data from the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2015; 37:19-25. [PMID: 26486597 DOI: 10.1017/ice.2015.252] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Case mix index (CMI) has been used as a facility-level indicator of patient disease severity. We sought to evaluate the potential for CMI to be used for risk adjustment of National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) data. METHODS NHSN facility-wide laboratory-identified Clostridium difficile infection event data from 2012 were merged with the fiscal year 2012 Inpatient Prospective Payment System (IPPS) Impact file by CMS certification number (CCN) to obtain a CMI value for hospitals reporting to NHSN. Negative binomial regression was used to evaluate whether CMI was significantly associated with healthcare facility-onset (HO) CDI in univariate and multivariate analysis. RESULTS Among 1,468 acute care hospitals reporting CDI data to NHSN in 2012, 1,429 matched by CCN to a CMI value in the Impact file. CMI (median, 1.49; interquartile range, 1.36-1.66) was a significant predictor of HO CDI in univariate analysis (P<.0001). After controlling for community onset CDI prevalence rate, medical school affiliation, hospital size, and CDI test type use, CMI remained highly significant (P<.0001), with an increase of 0.1 point in CMI associated with a 3.4% increase in the HO CDI incidence rate. CONCLUSIONS CMI was a significant predictor of NHSN HO CDI incidence. Additional work to explore the feasibility of using CMI for risk adjustment of NHSN data is necessary. Infect. Control Hosp. Epidemiol. 2015;37(1):19-25.
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David MZ, Siegel JD, Henderson J, Leos G, Lo K, Iwuora J, Porsa E, Schumm LP, Boyle-Vavra S, Daum RS. A randomized, controlled trial of chlorhexidine-soaked cloths to reduce methicillin-resistant and methicillin-susceptible Staphylococcus aureus carriage prevalence in an urban jail. Infect Control Hosp Epidemiol 2015; 35:1466-73. [PMID: 25419768 DOI: 10.1086/678606] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess an intervention to limit community-associated methicillin-resistant Staphylococcus aureus (MRSA) dissemination. DESIGN Randomized, controlled trial. SETTING County Jail, Dallas, Texas. PARTICIPANTS A total of 4,196 detainees in 68 detention tanks. METHODS Tanks were randomly assigned to 1 of 3 groups: in group 1, detainees received cloths that contained chlorhexidine gluconate (CHG) to clean their entire skin surface 3 times per week for 6 months; group 2 received identical cloths containing only water; and group 3 received no skin treatment. During the study, all newly arrived detainees were invited to enroll. Nares and hand cultures were obtained at baseline and from all current enrollees at 2 and 6 months. RESULTS At baseline, S. aureus was isolated from 41.2% and MRSA from 8.0% (nares and/or hand) of 947 enrollees. The average participation rate was 47%. At 6 months, MRSA carriage was 10.0% in group 3 and 8.7% in group 1 tanks (estimated absolute risk reduction [95% confidence interval (CI)], 1.4% [-4.8% to 7.1%]; P = .655). At 6 months, carriage of any S. aureus was 51.1% in group 3, 40.7% in group 1 (absolute risk reduction [95% CI], 10.4% [0.01%-20.1%]; P = .047), and 42.8% (absolute risk reduction [95% CI], 8.3% [-1.4% to 18.0%]; P = .099) in group 2. CONCLUSIONS Skin cleaning with CHG for 6 months in detainees, compared with no intervention, significantly decreased carriage of S. aureus, and use of water cloths produced a nonsignificant but similar decrease. A nonsignificant decrease in MRSA carriage was found with CHG cloth use. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00785200.
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Affiliation(s)
- Michael Z David
- Department of Medicine, University of Chicago, Chicago, Illinois
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Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals: 2014 Update. ACTA ACUST UNITED AC 2015. [DOI: 10.1017/s0195941700095412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Fox C, Wavra T, Drake DA, Mulligan D, Bennett YP, Nelson C, Kirkwood P, Jones L, Bader MK. Use of a patient hand hygiene protocol to reduce hospital-acquired infections and improve nurses' hand washing. Am J Crit Care 2015; 24:216-24. [PMID: 25934718 DOI: 10.4037/ajcc2015898] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Critically ill patients are at marked risk of hospital-acquired infections, which increase patients' morbidity and mortality. Registered nurses are the main health care providers of physical care, including hygiene to reduce and prevent hospital-acquired infections, for hospitalized critically ill patients. OBJECTIVE To investigate a new patient hand hygiene protocol designed to reduce hospital-acquired infection rates and improve nurses' hand-washing compliance in an intensive care unit. METHODS A preexperimental study design was used to compare 12-month rates of 2 common hospital-acquired infections, central catheter-associated bloodstream infection and catheter-associated urinary tract infection, and nurses' hand-washing compliance measured before and during use of the protocol. RESULTS Reductions in 12-month infection rates were reported for both types of infections, but neither reduction was statistically significant. Mean 12-month nurse hand-washing compliance also improved, but not significantly. CONCLUSIONS A hand hygiene protocol for patients in the intensive care unit was associated with reductions in hospital-acquired infections and improvements in nurses' hand-washing compliance. Prevention of such infections requires continuous quality improvement efforts to monitor lasting effectiveness as well as investigation of strategies to eliminate these infections.
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Affiliation(s)
- Cherie Fox
- Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California
| | - Teresa Wavra
- Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California
| | - Diane Ash Drake
- Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California
| | - Debbie Mulligan
- Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California
| | - Yvonne Pacheco Bennett
- Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California
| | - Carla Nelson
- Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California
| | - Peggy Kirkwood
- Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California
| | - Louise Jones
- Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California
| | - Mary Kay Bader
- Cherie Fox is nurse manager of the cardiac intensive care unit, Teresa Wavra is a clinical nurse specialist, Diane Ash Drake is a nurse research scientist, Debbie Mulligan is an infection prevention manager, Yvonne Pacheco Bennett is a staff nurse, Carla Nelson is a infection control practitioner, Peggy Kirkwood is a cardiovascular nurse practitioner, Louise Jones is a staff nurse, and Mary Kay Bader is a neurological/critical care clinical nurse specialist at Mission Hospital, Mission Viejo, California
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Marschall J, Mermel LA, Fakih M, Hadaway L, Kallen A, O'Grady NP, Pettis AM, Rupp ME, Sandora T, Maragakis LL, Yokoe DS. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35:753-71. [PMID: 25376071 DOI: 10.1086/676533] [Citation(s) in RCA: 292] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, Aureden K, Huang SS, Maragakis LL, Yokoe DS. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35:772-96. [PMID: 24915205 DOI: 10.1086/676534] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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O'Horo JC, Silva GLM, Munoz-Price LS, Safdar N. The Efficacy of Daily Bathing with Chlorhexidine for Reducing Healthcare-Associated Bloodstream Infections: A Meta-analysis. Infect Control Hosp Epidemiol 2015; 33:257-67. [DOI: 10.1086/664496] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Design.Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies to assess the efficacy of daily bathing with chlorhexidine (CHG) for prevention of healthcare-associated bloodstream infections (BSIs).Setting.Medical, surgical, trauma, and combined medical-surgical intensive care units (ICUs) and long-term acute care hospitals.Participants.Inpatients.Methods.Data on patient population, diagnostic criteria for BSIs, form and concentration of topical CHG, incidence of BSIs, and study design were extracted.Results.One randomized controlled trial and 11 nonrandomized controlled trials reporting a total of 137,392 patient-days met the inclusion criteria; 291 patients in the CHG arm developed a BSI over 67,775 patient-days, compared with 557 patients in the control arm over 69,617 catheter-days. CHG bathing resulted in a reduced incidence of BSIs: the pooled odds ratio using a random-effects model was 0.44 (95% confidence interval, 0.33–0.59; P< .00001). Statistical heterogeneity was moderate, with an I2 of 58%. For the subgroup of studies that examined central line–associated BSIs, the odds ratio was 0.40 (95% confidence interval, 0.27–0.59).Conclusions.Daily bathing with CHG reduced the incidence of BSIs, including central line-associated BSIs, among patients in the medical ICU. Further studies are recommended to determine the optimal frequency, method of application, and concentration of CHG as well as the comparative effectiveness of this strategy relative to other preventive measures available for reducing BSIs. Future studies should also examine the efficacy of daily CHG bathing in non-ICU populations at risk for BSI.Infect Control Hosp Epidemiol 2012;33(3):257-267
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Kassakian SZ, Mermel LA, Jefferson JA, Parenteau SL, Machan JT. Impact of Chlorhexidine Bathing on Hospital-Acquired Infections among General Medical Patients. Infect Control Hosp Epidemiol 2015; 32:238-43. [DOI: 10.1086/658334] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background.A paucity of data exists regarding the effectiveness of daily Chlorhexidine gluconate (CHG) bathing in non–intensive care unit (ICU) settings.Objective.To evaluate the effectiveness of daily CHG bathing in a non-ICU setting to reduce methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enteroccocus (VRE) hospital-acquired infections (HAIs), compared with daily bathing with soap and water.Design.Quasi-experimental study design; the primary outcome was the composite incidence of MRSA and VRE HAIs. Clostridium difficile HAI incidence was measured as a nonequivalent dependent variable with which to assess potential confounders.Setting.Four general medicine units, with a total of 94 beds, at a 719-bed academic tertiary-care facility in Providence, Rhode Island.Patients.A total of 7,102 and 7,699 adult patients were admitted to the medical service in the control and intervention groups, respectively. Patients admitted from January 1 through December 31, 2008, were bathed daily with soap and water (control group), and those admitted from February 1, 2009, through March 31, 2010, were bathed daily with CHG-impregnated cloths (intervention group).Results.Daily bathing with CHG was associated with a 64% reduced risk of developing the primary outcome, namely, the composite incidence of MRSA and VRE HAIs (hazard ratio, 0.36 [95% CI, 0.2-0.8]; P = .01). There was no change in the incidence of C. difficile HAIs (P = .6). Colonization with MRSA was associated with an increased risk of developing a MRSA HAI (hazard ratio, 8 [95% CI, 3-19]; P < .001).Conclusion.Daily CHG bathing was associated with a reduced HAI risk, using a composite endpoint of MRSA and VRE HAIs, in a general medical inpatient population.
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Whitman TJ, Herlihy RK, Schlett CD, Murray PR, Grandits GA, Ganesan A, Brown M, Mancuso JD, Adams WB, Tribble DR. Chlorhexidine-Impregnated Cloths to Prevent Skin and Soft-Tissue Infection in Marine Recruits: A Cluster-Randomized, Double-Blind, Controlled Effectiveness Trial. Infect Control Hosp Epidemiol 2015; 31:1207-15. [DOI: 10.1086/657136] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) causes skin and soft-tissue infection (SSTI) in military recruits.Objective.To evaluate the effectiveness of 2% Chlorhexidine gluconate (CHG)-impregnated cloths in reducing rates of SSTI and S. aureus colonization among military recruits.Design.A cluster-randomized (by platoon), double-blind, controlled effectiveness trial.Setting.Marine Officer Candidate School, Quantico, Virginia, 2007.Participants.Military recruits.Intervention.Application of CHG-impregnated or control (Comfort Bath; Sage) cloths applied over entire body thrice weekly.Measurements.Recruits were monitored daily for SSTI. Baseline and serial nasal and/or axillary swabs were collected to assess S. aureus colonization.Results.Of 1,562 subjects enrolled, 781 (from 23 platoons) underwent CHG-impregnated cloth application and 781 (from 21 platoons) underwent control cloth application. The rate of compliance (defined as application of 50% or more of wipes) at 2 weeks was similar (CHG group, 63%; control group, 67%) and decreased over the 6-week period. The mean 6-week SSTI rate in the CHG-impregnated cloth group was 0.094, compared with 0.071 in the control group (analysis of variance model rate difference, 0.025 ± 0.016; P = .14). At baseline, 43% of subjects were colonized with methicillin-susceptible S. aureus (MSSA), and 2.1% were colonized with MRSA. The mean incidence of colonization with MSSA was 50% and 61% (P = .026) and with MRSA was 2.6% and 6.0% (P = .034) for the CHG-impregnated and control cloth groups, respectively.Conclusions.CHG-impregnated cloths applied thrice weekly did not reduce rates of SSTI among recruits. S. aureus colonization rates increased in both groups but to a lesser extent in those assigned to the CHG-impregnated cloth Intervention. Antecedent S. aureus colonization was not a risk factor for SSTI. Additional studies are needed to identify effective measures for preventing SSTI among military recruits.Clinical Trials Registration.ClinicalTrials.gov identifier: NCT00475930.
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