 |
|
Chlorhexidine Gluconate to Cleanse Patients in a Medical Intensive Care Unit
The Effectiveness of Source Control to Reduce the Bioburden of Vancomycin-Resistant Enterococci
Michael O. Vernon, DrPH;
Mary K. Hayden, MD;
William E. Trick, MD;
Robert A. Hayes, BSc;
Donald W. Blom, RN;
Robert A. Weinstein, MD; for the Chicago Antimicrobial Resistance Project (CARP)
Arch Intern Med. 2006;166:306-312.
Background Historically, methods of interrupting pathogen transmission have focused on improving health care workers' adherence to recommended infection control practices. An adjunctive approach may be to use source control (eg, to decontaminate patients' skin).
Methods We performed a prospective sequential-group single-arm clinical trial in a teaching hospital's medical intensive care unit from October 2002 to December 2003. We bathed or cleansed 1787 patients and assessed them for acquisition of vancomycin-resistant enterococci (VRE). We performed a nested study of 86 patients with VRE colonization and obtained culture specimens from 758 environmental surfaces and 529 health care workers' hands. All patients were cleansed daily with the procedure specific to the study period as follows: period 1, soap and water baths; period 2, cleansing with cloths saturated with 2% chlorhexidine gluconate; and period 3, cloth cleansing without chlorhexidine. We measured colonization of patient skin by VRE, health care worker hand or environmental surface contamination by VRE, and patient acquisition of VRE rectal colonization.
Results Compared with soap and water baths, cleansing patients with chlorhexidine-saturated cloths resulted in 2.5 log10 less colonies of VRE on patients' skin and less VRE contamination of health care workers' hands (risk ratio [RR], 0.6; 95% confidence interval [CI], 0.4-0.8) and environmental surfaces (RR, 0.3; 95% CI, 0.2-0.5). The incidence of VRE acquisition decreased from 26 colonizations per 1000 patient-days to 9 per 1000 patient-days (RR, 0.4; 95% CI, 0.1-0.9). For all measures, effectiveness of cleansing with nonmedicated cloths was similar to that of soap and water baths.
Conclusion Cleansing patients with chlorhexidine-saturated cloths is a simple, effective strategy to reduce VRE contamination of patients' skin, the environment, and health care workers' hands and to decrease patient acquisition of VRE.
Author Affiliations: Department of Medicine, Stroger (Cook County) Hospital, Chicago, Ill (Drs Vernon, Trick, and Weinstein and Mr Hayes); and Department of Medicine, Rush Medical College, Chicago (Drs Hayden and Weinstein and Mr Blom).
 CiteULike  Connotea  Delicious  Digg  Facebook  Reddit  Technorati  Twitter
What's this?
RELATED ARTICLE
Universal Patient Disinfection as a Tool for Infection Control: Rub-A-Dub-Dub, No Need for a Tub
Lance R. Peterson and Kamaljit Singh
Arch Intern Med. 2006;166(3):274-276.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Has decolonization played a central role in the decline in UK methicillin-resistant Staphylococcus aureus transmission? A focus on evidence from intensive care
Edgeworth
J Antimicrob Chemother 2011;66:ii41-ii47.
ABSTRACT
| FULL TEXT
Chlorhexidine Gluconate Bathing: Does it Decrease Hospital-Acquired Infections?
Sievert et al.
Am J Crit Care 2011;20:166-170.
FULL TEXT
Community-Associated Methicillin-Resistant Staphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic
David and Daum
Clin. Microbiol. Rev. 2010;23:616-687.
ABSTRACT
| FULL TEXT
Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients
Evans et al.
Arch Surg 2010;145:240-246.
ABSTRACT
| FULL TEXT
Efficacy and Limitation of a Chlorhexidine-Based Decolonization Strategy in Preventing Transmission of Methicillin-Resistant Staphylococcus aureus in an Intensive Care Unit
Batra et al.
Clinical Infectious Diseases 2010;50:210-217.
ABSTRACT
| FULL TEXT
Prevention and Control of Methicillin-Resistant Staphylococcus aureus: Dealing With Reality, Resistance, and Resistance to Reality
Jarvis
Clinical Infectious Diseases 2010;50:218-220.
FULL TEXT
Formulation of a model for automating infection surveillance: algorithmic detection of central-line associated bloodstream infection
Hota et al.
J Am Med Inform Assoc 2010;17:42-48.
ABSTRACT
| FULL TEXT
Skin and Environmental Contamination with Methicillin-Resistant Staphylococcus aureus among Carriers Identified Clinically Versus through Active Surveillance
Chang et al.
Clinical Infectious Diseases 2009;48:1423-1428.
ABSTRACT
| FULL TEXT
Patients' Bath Basins as Potential Sources of Infection: A Multicenter Sampling Study
Johnson et al.
Am J Crit Care 2009;18:31-40.
ABSTRACT
| FULL TEXT
Ethical Implications of Active Surveillance Cultures and Contact Precautions for Controlling Multidrug Resistant Organisms in the Hospital Setting
Edmond et al.
Public Health Ethics 2008;1:235-245.
ABSTRACT
| FULL TEXT
Clostridium difficile Skin Contamination in Patients with C. difficile-Associated Disease
Bobulsky et al.
Clinical Infectious Diseases 2008;46:447-450.
ABSTRACT
| FULL TEXT
Chlorhexidine: Expanding the Armamentarium for Infection Control and Prevention
Weinstein et al.
Clinical Infectious Diseases 2008;46:274-281.
ABSTRACT
| FULL TEXT
Effectiveness of Chlorhexidine Bathing to Reduce Catheter-Associated Bloodstream Infections in Medical Intensive Care Unit Patients
Bleasdale et al.
Arch Intern Med 2007;167:2073-2079.
ABSTRACT
| FULL TEXT
Bed-Bath, and Beyond?
Journal Watch Dermatology 2006;2006:4-4.
FULL TEXT
Bed-Bath, and Beyond?
JWatch Infect. Diseases 2006;2006:3-3.
FULL TEXT
Universal Patient Disinfection as a Tool for Infection Control: Rub-A-Dub-Dub, No Need for a Tub
Peterson and Singh
Arch Intern Med 2006;166:274-276.
FULL TEXT
|
