Real-world experience of how chlorhexidine bathing affects the acquisition and incidence of vancomycin-resistant enterococci (VRE) in a medical intensive care unit with VRE endemicity: a prospective interrupted time-series study

Abstract

Background Critically ill patients in intensive care units (ICUs) often acquire opportunistic infections or are colonized by vancomycin-resistant enterococci (VRE), which limits therapeutic options and results in high case-fatality rates. In clinical practice, the beneficial effects of universal chlorhexidine gluconate (CHG) bathing on the control of VRE remain unclear. This study aimed to investigate whether 2% CHG daily bathing reduced the acquisition of VRE in the setting of a medical ICU (MICU) with VRE endemicity. Methods This quasi-experimental intervention study was conducted in a 23-bed MICU of a tertiary care hospital in Korea from September 2016 to December 2017. In a prospective, interrupted time-series analysis (ITS) with a 6-month CHG bathing intervention, we compared the acquisition and incidence of VRE and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) between the pre-intervention and intervention periods. The primary and secondary outcomes were a change in the acquisition of VRE and incidence of VRE, MRSA, or CRAB between the two periods, respectively. Results All the adult patients admitted to the MICU were enrolled in the pre-intervention (n = 259) and intervention (n = 242). The overall CHG daily bathing compliance rate was 72.5%. In the ITS, there was a significant intervention effect with a 58% decrease in VRE acquisition (95% CI 7.1–82.1%, p = 0.038) following the intervention. However, there was no significant intervention effects on the incidence trend of VRE, MRSA, and CRAB determined by clinical culture between the pre-intervention and intervention periods. Conclusion In this real-world study, we concluded that daily bathing with CHG may be an effective measure to reduce VRE cross-transmission among patients in MICU with a high VRE endemicity.

Carbapenem-resistant Acinetobacter baumannii: A challenge in the intensive care unit

“…Chung et al observed a 51.8% reduction in CRAB infection rates after daily chlorhexidine bathing in ICUs with CRAB endemicity ( Chung et al, 2015 ). Other studies also indicated that daily bathing with 2% chlorhexidine gluconate can reduce CRAB cross-transmission among patients in ICUs with high CRAB endemicity ( Hong et al, 2018 ; Metan et al, 2020 ; Suh et al, 2021 ). Moreover, environmental cleaning, isolation, and enhanced contact precautions are also integrated into strategies preventing CRAB cross-transmission among patients in ICUs because of the environmental reservoirs of CRAB.…”

Baño del Paciente con Clorhexidina en Unidad de Cuidados Intensivos para la Prevención de Infecciones Asociadas a la Atención en Salud

“…En su estudio (Suh et al 2021) (Tien et al 2021) muestran que el baño con clorhexidina es capaz de disminuir hasta en un 70% la incidencia de infecciones asociadas a Enterococcus resistentes a la Vancomicina. (Musuuza et al 2019) (Reis et al 2022) (Scheier et al 2021) (Martinez et al 2020) declaran que el uso del baño con clorhexidina en pacientes críticos se relaciona fuertemente con una disminución de las infecciones del torrente sanguíneo.…”

The Impact of Enterococcus spp. in the Immunocompromised Host: A Comprehensive Review

“…Enhanced environmental cleaning methods may be recommended due to documented instances of persistent VRE presence in hospital rooms despite standard cleaning procedures [207,208]. Recent studies have demonstrated that decolonization through the use of chlorhexidine gluconate bathing for patients in Intensive Care Units (ICU) can prevent hospital-acquired infections and reduce the acquisition rate of MDR organisms including VRE [209]; this could be a potentially interesting path to follow for wards characterized by the presence of immunocompromised patients. Published data highlight the possibility of using capsular and cell wall polysaccharides as targets for immunotherapeutic choices.…”