Daily bathing strategies and cross-transmission of multidrug-resistant organisms: Impact of chlorhexidine-impregnated wipes in a multidrug-resistant gram-negative bacteria endemic intensive care unit

Ruiz-Ramos, Jesús; Ramírez, Paula; Villarreal, Esther; Gordón, Mónica; Saez, Inmaculada; Rodríguez, Alfonso J.; Castañeda, María Jesús; Castellanos-Ortega, Álvaro

doi:10.1016/j.ajic.2017.06.029

Cited by 12 publications

(32 citation statements)

References 36 publications

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“…Although some studies did not show an effect on HAIs, these were considerably smaller than the 2 studies by Huang et al 13 , 23 A 2015 rigorous cluster-randomized trial by Noto et al 25 found no impact on CLABSI, CAUTI, VAP, or Clostridioides difficile infection rates among the 9340 patients in the study. Ruiz et al 16 observed reduced MDRO colonization in their single-site study, but this did not lead to a reduction in HAIs. In addition, they noted that longer ICU stays were associated with higher overall incidence of HAIs, regardless of chlorhexidine bathing.…”

Section: Resultsmentioning

confidence: 83%

“…Three systematic reviews and 3 studies (2 experimental, 1 quasi-experimental) found evidence that chlorhexidine bathing reduces MRSA acquisition and carriage, although one review did include studies where no reduction was found. 7 , 11 , 12 , 14 , 15 , 17 A prospective cohort study by Ruiz et al 16 (2017) found no reduction in MRSA colonization rates but did find a significant reduction in total MDRO colonization.…”

Section: Resultsmentioning

confidence: 99%

“…Of those that did, 2 observational cohort studies found that chlorhexidine bathing can reduce CRE colonization and potentially CRE infection. 16 , 19 …”

Section: Resultsmentioning

confidence: 99%

“… 12 , 17 , 29 One review found only temporary decolonization of MDR-GNB using chlorhexidine, and 1 randomized, open-label controlled trial found no reduction or delay in MDR-GNB acquisition. 20 , 29 Kengen et al’s 24 retrospective time study (2018) found no difference in MDRO acquisition with chlorhexidine bathing as compared with soap and water, whereas Ruiz et al 16 (2017) saw a reduction in MDRO acquisition, including MDR-GNB. 16 , 24 Musuuza et al’s 14 pre-post study (2017) found reduced MDR-GNB colonization with chlorhexidine bathing, but Mendes et al’s 18 quasi-experimental observational study did not.…”

Section: Resultsmentioning

confidence: 99%

“… 20 , 29 Kengen et al’s 24 retrospective time study (2018) found no difference in MDRO acquisition with chlorhexidine bathing as compared with soap and water, whereas Ruiz et al 16 (2017) saw a reduction in MDRO acquisition, including MDR-GNB. 16 , 24 Musuuza et al’s 14 pre-post study (2017) found reduced MDR-GNB colonization with chlorhexidine bathing, but Mendes et al’s 18 quasi-experimental observational study did not. Maxwell et al 27 (2017) found no difference between chlorhexidine and soap bathing for lowering all-MDRO infection rates.…”

Section: Resultsmentioning

confidence: 99%

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Chlorhexidine Bathing Strategies for Multidrug-Resistant Organisms: A Summary of Recent Evidence

Gall

Long²,

Hall³

2020

J Patient Saf

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Objective The aim of the study was to summarize the latest evidence for patient bathing with a 2% to 4% chlorhexidine gluconate solution to reduce multidrug-resistant organism (MDRO) transmission and infection. Methods We searched 3 databases (CINAHL, MEDLINE, and Cochrane) for a combination of the key words “chlorhexidine bathing” and MeSH terms “cross-infection prevention,” “drug resistance, multiple, bacterial,” and “drug resistance, microbial.” Articles from January 1, 2008, to December 31, 2018, were included, as well as any key articles published after December 31. Results Our findings focused on health care–associated infections (HAIs) and 3 categories of MDROs: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Enterobacteriaceae (CRE). Chlorhexidine bathing reduces MRSA acquisition and carriage, but not all studies found significant reductions in MRSA infections. Several studies found that chlorhexidine bathing reduced VRE acquisition and carriage, and one study showed lower VRE infections in the bathing group. Two studies found that bathing reduced CRE carriage (no studies examined CRE infections). Two very large studies (more than 140,000 total patients) found bathing significantly reduced HAIs, but these reductions may be smaller when HAIs are already well controlled by other means. Conclusions There is a high level of evidence supporting chlorhexidine bathing to reduce MDRO acquisition; less evidence is available on reducing infections. Chlorhexidine bathing is low cost to implement, and adverse events are rare and resolve when chlorhexidine use is stopped. There is evidence of chlorhexidine resistance, but not at concentrations in typical use. Further research is needed on chlorhexidine bathing’s impact on outcomes, such as mortality and length of stay.

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Section: Resultsmentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

“…Of those that did, 2 observational cohort studies found that chlorhexidine bathing can reduce CRE colonization and potentially CRE infection. 16 , 19 …”

Section: Resultsmentioning

confidence: 99%