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

Published online by Cambridge University Press:  10 May 2016

Melissa A. Viray ,
James C. Morley ,
Craig M. Coopersmith ,
Marin H. Kollef ,
Victoria J. Fraser  and
David K. Warren
Melissa A. Viray
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
James C. Morley
Affiliation:
University of New South Wales, Sydney, Australia
Craig M. Coopersmith
Affiliation:
Emory University School of Medicine, Atlanta, Georgia
Marin H. Kollef
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Victoria J. Fraser
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
David K. Warren*
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
*
Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110 (dwarren@dom.wustl.edu)
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Abstract

Objective.

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

Design.

Prospective pre-post-intervention study with control unit.

Setting.

A 1,250-bed tertiary care teaching hospital.

Patients.

Medical and surgical ICU patients.

Methods.

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

Results.

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

Conclusions.

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

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 3 , March 2014 , pp. 243 - 250
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Anderson, DJ, Kaye, KS, Chen, LF, et al. Clinical and financial outcomes due to methicillin resistant Staphylococcus aureus surgical site infection: a multi-center matched outcomes study. PLOS ONE 2009;4:e8305.Google Scholar
2. Filice, GA, Nyman, JA, Lexau, C, et al. Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2010;31: 365–373.Google Scholar
3. Rubio-Terres, C, Garau, J, Grau, S, Martinez-Martinez, L. Cost of bacteraemia caused by methicillin-resistant vs. methicillin-sus-ceptible Staphylococcus aureus in Spain: a retrospective cohort study. Clin Microbiol Infect 2010;16:722–728.CrossRefGoogle ScholarPubMed
4. de Kraker, ME, Wolkewitz, M, Davey, PG et al. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother 2011;55:1598–1605.CrossRefGoogle ScholarPubMed
5. Hanberger, H, Walther, S, Leone, M et al. Increased mortality associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in the intensive care unit: results from the EPIC II study. Int J Antimicrob Agents 2011;38:331–335.Google Scholar
6. Mortimer, EA Jr, Lipsitz, PJ, Wolinksky, E, Gonzaga, AJ, Rammelkamp, CH Jr. Transmission of staphylococci between newborns: importance of the hands to personnel. Am J Dis Child 1962;104:289–295.CrossRefGoogle Scholar
7. Humphreys, H. Can we do better in controlling and preventing methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU)? Eur J Clin Microbiol Infect Dis 2008;27: 409–413.CrossRefGoogle ScholarPubMed
8. Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Entero-coccus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009; 37:1858–1865.CrossRefGoogle Scholar
9. Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Blom, DW, Weinstein, RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166:306–312.Google Scholar
10. Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily Chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533–542.Google Scholar
11. Batra, R, Cooper, BS, Whiteley, C, Patel, AK, Wyncoll, D, Edge-worth, JD. Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillinresistant Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2010;50:210–217.Google Scholar
12. Fraser, TG, Fatica, C, Scarpelli, M, et al. Decrease in Staphylococcus aureus colonization and hospital-acquired infection in a medical intensive care unit after institution of an active surveillance and decolonization program. Infect Control Hosp Epidemiol 20l0;3l:779–783.Google Scholar
13. Ridenour, G, Lampen, R, Federspiel, J, Kritchevsky, S, Wong, E, Climo, M. Selective use of intranasal mupirocin and Chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007;28:1155–1161.Google Scholar
14. Sandri, AM, Dalarosa, MG, Ruschel de, AL, da Silva, EL, Zavascki, AP. Reduction in incidence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in an intensive care unit: role of treatment with mupirocin ointment and Chlorhexidine baths for nasal carriers of MRSA. Infect Control Hosp Epidemiol 2006;27:185–187.Google Scholar
15. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:2255–2265.CrossRefGoogle ScholarPubMed
16. Evans, HL, Dellit, TH, Chan, J, Nathens, AB, Maier, RV, Cuschieri, J. Effect of Chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg 2010;145: 240–246.CrossRefGoogle ScholarPubMed
17. Gould, IM, MacKenzie, FM, MacLennan, G, Pacitti, D, Watson, EJ, Noble, DW. Topical antimicrobials in combination with admission screening and barrier precautions to control endemic methicillin-resistant Staphylococcus aureus in an intensive care unit. Int f Antimicrob Agents 2007;29:536–543.Google Scholar
18. Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of Chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:2073–2079.CrossRefGoogle ScholarPubMed
19. Warren, DK, Guth, RM, Coopersmith, CM, Merz, LR, Zack, JE, Fraser, VJ. Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit. Infect Control Hosp Epidemiol 2006;27:1032–1040.Google Scholar
20. Perry, AG, Potter, PA. Clinical Nursing Skills and Techniques. 5th ed. St. Louis: Mosby, 2001.Google Scholar
21. Honda, H, Krauss, MJ, Coopersmith, CM, et al. Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does methicillin resistance matter? Infect Control Hosp Epidemiol 2010;31:584–591.CrossRefGoogle ScholarPubMed
22. Andrews, DWK, Ploberger, W. Optimal tests when a nuisance parameter is present only under the alternative. Econometrica 1994;62:1383–1414.Google Scholar
23. Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Effectiveness of routine patient cleansing with Chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30:959–963.Google Scholar
24. Milstone, AM, Elward, A, Song, X, et al. Daily Chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial. Lancet 2013;381:1099–1106.Google Scholar