Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-24T17:58:09.077Z Has data issue: false hasContentIssue false
  • English
  • Français

Relationship between Chlorhexidine Gluconate Skin Concentration and Microbial Density on the Skin of Critically Ill Patients Bathed Daily with Chlorhexidine Gluconate

Published online by Cambridge University Press:  02 January 2015

Kyle J. Popovich ,
Rosie Lyles ,
Robert Hayes ,
Bala Hota ,
William Trick ,
Robert A. Weinstein  and
Mary K. Hayden
Kyle J. Popovich*
Affiliation:
Rush University Medical Center, Chicago, Illinois Stroger Hospital of Cook County, Chicago, Illinois
Rosie Lyles
Affiliation:
Stroger Hospital of Cook County, Chicago, Illinois
Robert Hayes
Affiliation:
Rush University Medical Center, Chicago, Illinois
Bala Hota
Affiliation:
Rush University Medical Center, Chicago, Illinois Stroger Hospital of Cook County, Chicago, Illinois
William Trick
Affiliation:
Stroger Hospital of Cook County, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Rush University Medical Center, Chicago, Illinois Stroger Hospital of Cook County, Chicago, Illinois
Mary K. Hayden
Affiliation:
Rush University Medical Center, Chicago, Illinois
*
Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective and Design.

Previous work has shown that daily skin cleansing with Chlorhexidine gluconate (CHG) is effective in preventing infection in the medical intensive care unit (MICU). A colorimetric, semiquantitative indicator was used to measure CHG concentration on skin (neck, antecubital fossae, and inguinal areas) of patients bathed daily with CHG during their MICU stay and after discharge from the MICU, when CHG bathing stopped.

Patients and Setting.

MICU patients at Rush University Medical Center.

Methods.

CHG concentration on skin was measured and skin sites were cultured quantitatively. The relationship between CHG concentration and microbial density on skin was explored in a mixed-effects model using gram-positive colony-forming unit (CFU) counts.

Results.

For 20 MICU patients studied (240 measurements), the lowest CHG concentrations (0–18.75 μg/mL) and the highest gram-positive CFU counts were on the neck (median, 1.07 log10 CFUs; P = .014). CHG concentration increased postbath and decreased over 24 hours (P < .001). In parallel, median log10 CFUs decreased pre- to postbath (0.78 to 0) and then increased over 24 hours to the baseline of 0.78 (P = .001). A CHG concentration above 18.75 μg/mL was associated with decreased gram-positive CFUs (P = .004). In all but 2 instances, CHG was detected on patient skin during the entire interbath (approximately 24-hour) period (18 [90%] of 20 patients). In 11 patients studied after MICU discharge (80 measurements), CHG skin concentrations fell below effective levels after 1–3 days.

Conclusion.

In MICU patients bathed daily with CHG, CHG concentration was inversely associated with microbial density on skin; residual antimicrobial activity on skin persisted up to 24 hours. Determination of CHG concentration on the skin of patients may be useful in monitoring the adequacy of skin cleansing by healthcare workers.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 9 , September 2012 , pp. 889 - 896
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

Access options

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

References

1. O'Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52(9):e162–e193.10.1093/cid/cir257Google Scholar
2. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus . Infect Control Hosp Epidemiol 2003;24(5):362–386.10.1086/502213Google Scholar
3. Larson, EL, McGinley, KJ, Foglia, AR, Talbot, GH, Leyden, JJ. Composition and antimicrobic resistance of skin flora in hospitalized and healthy adults. J Clin Microbiol 1986;23(3):604–608.10.1128/jcm.23.3.604-608.1986Google Scholar
4. Fridkin, SK, Gaynes, RR Antimicrobial resistance in intensive care units. Clin Chest Med 1999;20(2):303–316, viii.10.1016/S0272-5231(05)70143-XGoogle Scholar
5. O'Grady, NR Alexander, M, Dellinger, ER et al. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002;23(12):759–769.10.1017/S0195941700080577Google Scholar
6. 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(3):306–312.10.1001/archinte.166.3.306Google Scholar
7. 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(19):2073–2079.10.1001/archinte.167.19.2073Google Scholar
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 Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009;37(6):1858–1865.10.1097/CCM.0b013e31819ffe6dGoogle Scholar
9. 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 2011;145(3):240–246.10.1001/archsurg.2010.5Google Scholar
10. 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(10):959–963.10.1086/605925Google Scholar
11. Edmiston, CE Jr, Krepel, CJ, Seabrook, GR, Lewis, BD, Brown, KR, Towne, JB. Preoperative shower revisited: can high topical antiseptic levels be achieved on the skin surface before surgical admission? J Am Coll Surg 2008;207(2):233–239.10.1016/j.jamcollsurg.2007.12.054Google Scholar
12. Garland, JS, Alex, CP, Mueller, CD, et al. A randomized trial comparing povidone-iodine to a Chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 2001;107(6):1431–1436.10.1542/peds.107.6.1431Google Scholar
13. Lowbury, EJ, Lilly, HA. Use of 4 per cent Chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection. Br Med J 1973;1(5852):510–515.10.1136/bmj.1.5852.510Google Scholar
14. Lorente, L, Henry, C, Martin, MM, Jimenez, A, Mora, ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Crit Care 2005;9(6):R631–R635.10.1186/cc3824Google Scholar
15. Mermel, LA, McCormick, RD, Springman, SR, Maki, DG. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med 1991;91(3B):197S–205S.10.1016/0002-9343(91)90369-9Google Scholar
16. Heard, SO, Wagle, M, Vijayakumar, E, et al. Influence of triple-lumen central venous catheters coated with Chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia. Arch Intern Med 1998;158(1):81–87.Google Scholar
17. Vernon, MO, Blom, DW, Hayes, RA, et al. Efficacy of a Chlorhexidine gluconate (CHG) body cleanser for reducing skin contamination with vancomycin-resistant enterococci (VRE) among intensive care unit (ICU) patients. Paper presented at: 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; September 14-17, 2003; Chicago. Abstract K-1108.Google Scholar
18. Darouiche, RO, Mansouri, MD, Gawande, PV, Madhyastha, S. Efficacy of combination of Chlorhexidine and protamine sulphate against device-associated pathogens. J Antimicrob Chemother 2008;61(3):651–657.10.1093/jac/dkn006Google Scholar
19. Koljalg, S, Naaber, P, Mikelsaar, M. Antibiotic resistance as an indicator of bacterial Chlorhexidine susceptibility. J Hosp Infect 2002;51(2):106–113.10.1053/jhin.2002.1204Google Scholar
20. Pittet, D, Mourouga, P, Perneger, TV; Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130(2):126–130.10.7326/0003-4819-130-2-199901190-00006Google Scholar
21. Eckmanns, T, Bessert, J, Behnke, M, Gastmeier, P, Rüden, H. Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect. Infect Control Hosp Epidemiol 2006;27(9):931–934.10.1086/507294Google Scholar