Chlorhexidine gluconate use to prevent hospital acquired infections—a useful tool, not a panacea

Wang, Elizabeth Wenqian; Layon, A. Joseph

doi:10.21037/atm.2017.01.01

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…Las propiedades antisépticas del digluconato de clorhexidina han sido bien documentadas en la literatura, se lo ha empleado para disminuir el riesgo de infecciones en procedimientos quirúrgicos, así como para inducir tejido de granulación en cirugías periodontales y evitar infecciones intrahospitalarias. [1][2][3][4][6][7][8] En un estudio de Hamill y cols., sobre modelos de abrasión corneal en conejos, se observó que la irrigación con gluconato de clorhexidina al 2% y 4% disminuyó la tasa de re-epitelización, pero esto no ocurría con concentraciones del 1%. 9 En otro estudio similar de Platt y Bucknall, pero en heridas infectadas de cobayos, la irrigación con gluconato de clorhexidina impidió totalmente la sepsis y no disminuyó la velocidad de cicatrización de la herida.…”

Section: Discussionunclassified

“…1 Se emplea comúnmente para la higiene bucal, la preparación prequirúrgica de los pacientes y para evitar infecciones intrahospitalarias por microorganismos multirresistentes. 1,2 La clorhexidina es una bisbiguanida y existe en forma catiónica a pH fisiológico que interactúa con las cargas negativas de las paredes celulares alterando el equilibrio osmótico de la célula bacteriana y causando la precipitación de los contenidos celulares. 3,4 Al ser insoluble en agua, normalmente se combina con ácido glucónico que forma una sal soluble útil para aplicaciones clínicas.…”

Section: Introductionunclassified

“…3,4 El comienzo de su acción es rápido, aproximadamente de 20 segundos, y el efecto residual es prolongado. 2 Se ha documentado la persistencia de la acción hasta 48 h poscontacto. 4 A bajas concentraciones, es bacteriostática (0,0002 al 0,5%), pero a altas concentraciones, es bactericida (>05%).…”

Section: Introductionunclassified

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Uso del gluconato de clorhexidina en la curación de heridas y su potencial formación de tejido de granulación

Wagner¹,

Sala²

2019

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: Las heridas con defectos de coberturas suponen un gran desafío a la hora de elegir un buen tratamiento que reduzca el riesgo de infección e incremente la capacidad de granulación del tejido. El objetivo de este estudio fue demostrar la utilidad del digluconato de clorhexidina para la granulación de tejidos. Materiales y Métodos: Se incluyeron 18 heridas de 16 pacientes que cumplían con los criterios de inclusión. Se realizaron curaciones ambulatorias con gasas embebidas en digluconato de clorhexidina al 20%, cada 48-72 h, hasta lograr la adecuada granulación de tejido y se tomaron fotografías de la evolución clínica de las heridas. Resultados: Se observó una adecuada granulación de las heridas en una media de 9.2 días (rango 4-25), independientemente del tamaño o de las comorbilidades. Ninguna herida presentó signos clínicos de infección durante el período de curación. Conclusiones: El uso de digluconato de clorhexidina es un adecuado método por tener en cuenta para tratar heridas, de forma ambulatoria, y así disminuir los costos hospitalarios del sistema de salud.

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Section: Discussionunclassified

Section: Introductionunclassified

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Uso del gluconato de clorhexidina en la curación de heridas y su potencial formación de tejido de granulación

Wagner¹,

Sala²

2019

Rev. Asoc. Arg. Ort. y Traumatol

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“…Tidal volume (V T ), Peak inspiratory airway pressure (P Insp ), PEEP, inspiratory esophageal pressure (P EsInsp ) and end-expiratory esophageal pressure (P EsExp ) were recorded from the ventilator. Values for ΔP and transpulmonary pressure (ΔP L ) were calculated as previously described [ 15 ]. Transpulmonary inspiratory pressure (TPP Insp ) was calculated as TTP Insp = P Insp − P EsInsp and transpulmonary expiratory pressure (TPP Exp ) as TPP Exp = PEEP − P EsExp .…”

Section: Methodsmentioning

confidence: 99%

Prospective Observational Study to Evaluate the Effect of Different Levels of Positive End-Expiratory Pressure on Lung Mechanics in Patients with and without Acute Respiratory Distress Syndrome

Fiedler

Diktanaite

Simeliunas

et al. 2020

JCM

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Background: The optimal level of positive end-expiratory pressure is still under debate. There are scare data examining the association of PEEP with transpulmonary pressure (TPP), end-expiratory lung volume (EELV) and intraabdominal pressure in ventilated patients with and without ARDS. Methods: We analyzed lung mechanics in 3 patient groups: group A, patients with ARDS; group B, obese patients (body mass index (BMI) > 30 kg/m2) and group C, a control group. Three levels of PEEP (5, 10, 15 cm H2O) were used to investigate the consequences for lung mechanics. Results: Fifty patients were included, 22 in group A, 18 in group B (BMI 38 ± 2 kg/m2) and 10 in group C. At baseline, oxygenation showed no differences between the groups. Driving pressure (ΔP) and transpulmonary pressure (ΔPL) was higher in group B than in groups A and C at a PEEP of 5 cm H2O (ΔP A: 15 ± 1, B: 18 ± 1, C: 14 ± 1 cm H2O; ΔPL A: 10 ± 1, B: 13 ± 1, C: 9 ± 0 cm H2O). Peak inspiratory pressure (Pinsp) rose in all groups as PEEP increased, but the resulting driving pressure and transpulmonary pressure were reduced, whereas EELV increased. Conclusion: Measuring EELV or TPP allows a personalized approach to lung-protective ventilation.

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“…Antibiotic lock solutions have proven an effective means of decreasing incidence of CLABSI [27]; however, research has shown that their use quickly leads to antibiotic resistance [28]. Recent studies have demonstrated the effective role of topical chlorhexidine gluconate (CHG) for reducing CLABSI [29]. CHG is a broadspectrum biocide with rapid onset of action, prolonged antimicrobial effects, and excellent efficacy against gram-positive organisms [30].…”

Section: Relevant Medical Literaturementioning

confidence: 99%

Chlorhexidine locking device for central line infection prevention in ICU patients: protocol for an open-label pilot and feasibility randomized controlled trial

Zamir

Pook

McDonald

et al. 2020

Pilot Feasibility Stud

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Background Critically ill patients in the intensive care unit (ICU) are at risk for central line-associated bloodstream infection (CLABSI) with an incidence up to 6.9 per 1000 catheter days. CLABSI has a significant attributable mortality and increases in-hospital length of stay, readmissions, and costs. Chlorhexidine gluconate (CHG), a broad-spectrum biocide, has been shown to effectively reduce infections including CLABSI; however, few trials have utilized CHG for prevention of central line infections. Our preclinical work has demonstrated a device that diffuses CHG into the intravenous lock solution of central venous catheters and decreases bacterial growth on the catheter lumen. We designed a clinical trial to test the feasibility of using a CHG device in an ICU patient population. Methods The proposed pilot trial will be a single centre, open-label, two-arm, parallel group feasibility randomized controlled trial (RCT). Participants will have a central line in situ and will be enrolled within 72 h of admittance to 3 ICUs at a single academic hospital. Exclusion criteria will include suspected infection, chronic indwelling catheters, and CHG allergy. Informed consent will be obtained from eligible participants or their substitute decision maker prior to randomization. Participants will be randomized to receive either usual care or the CHG locking device. Blood cultures will be drawn from all participants every 48 h. The primary objective of this study will be to determine the feasibility of using this protocol to conduct a larger trial. Feasibility will be assessed through the following outcomes: (1) consent rate, (2) recruitment rate, (3) protocol adherence, and (4) comfort level with the device. The secondary objective of this study will be to establish the preliminary efficacy of the device. Discussion This study will be the first human RCT to investigate a CHG locking device for the prevention of central line infections. Findings from this trial will inform the feasibility of conducting a large RCT and provide preliminary data on the efficacy of a CHG locking device. Trial registration ClinicalTrials.gov, NCT03309137, registered on October 13, 2017.

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Chlorhexidine gluconate use to prevent hospital acquired infections—a useful tool, not a panacea

Cited by 14 publications

References 12 publications

Uso del gluconato de clorhexidina en la curación de heridas y su potencial formación de tejido de granulación

Uso del gluconato de clorhexidina en la curación de heridas y su potencial formación de tejido de granulación

Prospective Observational Study to Evaluate the Effect of Different Levels of Positive End-Expiratory Pressure on Lung Mechanics in Patients with and without Acute Respiratory Distress Syndrome

Chlorhexidine locking device for central line infection prevention in ICU patients: protocol for an open-label pilot and feasibility randomized controlled trial

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