I N F E C T I O N C O N T R O L AND H O S P I T A L E P I D E M I O L O G Y

ORIGINAL

MARCH 2 0 1 4 , VOL. 3 5 , N O . 3

ARTICLE

Daily Bathing with Chlorhexidine-Based Soap and the Prevention of Staphylococcus aureus Transmission and Infection Melissa A. Viray, MD; 1 James C. Morley, PhD;2 Craig M. Coopersmith, MD; 3 Marin H. Kollef, MD;1 Victoria J. Fraser, MD;1 David K. Warren, MD, MPH1

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. SETTING. PATIENTS.

Prospective pre-post-intervention study with control unit. A 1,250-bed tertiary care teaching hospital. 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; /3, —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; /3, -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. Infect Control Hosp Epidemiol 2014;35(3):243-250

Staphylococcus aureus is a major cause of healthcare-associated asymptomatic colonization and prompt earlier contact preinfections, particularly among critically ill patients. Methicautions, and decolonizing MRSA-colonized patients. 7 Chlorcillin-resistant S. aureus (MRSA) has caused an increasing hexidine gluconate, a topical antiseptic, has been used in proportion of intensive care unit (ICU)-acquired S. aureus preprocedural skin antisepsis and to eliminate MRSA carinfections in the United States over the past 20 years. Comriage. Recent data have emerged to support the use of chlorpared with methicillin-susceptible S. aureus (MSSA), MRSA hexidine skin antisepsis to prevent the transmission of drugresistant organisms, such as vancomycin-resistant enterococci infections are associated with increased costs1"3 and mortal(VRE) and MRSA, in ICUs. 810 Several studies have evaluated iry.4,5 the use of chlorhexidine-based skin antisepsis, with or withTransmission of S. aureus between hospitalized patients has long been felt to primarily occur via the hands of healthcare out intranasal therapy to decolonize MRSA-colonized ICU workers. 6 Multiple interventions have been undertaken to patients,11"14 and reported decreases in MRSA acquisition, 11 interrupt MRSA transmission in healthcare settings, including colonization, 1213 and infection. 1314 Additionally, bathing all improving healthcare worker hand hygiene compliance, inICU patients daily with a chlorhexidine-based soap has been stituting contact precautions for patients colonized or inshown to decrease acquisition of MRSA,8,15 colonization with fected with MRSA, performing active surveillance to identify MRSA16 and MRSA infection.17 However, few studies8,17 exAffiliations: 1. Washington University School of Medicine, St. Louis, Missouri; 2. University ofNew South Wales, Sydney, Australia; 3. Emory University School of Medicine, Atlanta, Georgia. Received July 11, 2013; accepted November 25, 2013; electronically published January 24, 2014. © 2014 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2014/3503-0006$15.00. DOI: 10.1086/675292

Downloaded from https:/www.cambridge.org/core. New York University, on 21 Feb 2017 at 10:38:56, subject to the Cambridge Core terms of use, available at https:/www.cambridge.org/core/terms. https://doi.org/10.1086/675292

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I N F E C T I O N CONTROL AND H O S P I T A L E P I D E M I O L O G Y

TABLE

M A R C H 2 0 1 4 , VOL. 3 5 , N O . 3

i. Characteristics of the Intervention and Control Intensive Care Units

Variable No. of beds Patient days, totalb Ventilator utilization ratio, monthly, median (range)b Central venous catheter utilization ratio, monthly, median (range)b Patient characteristics, monthly proportion, median (range)c Decubitus ulcer (stage II or greater) Tracheostomy Enteral tube feeding MRSA colonization at admission

Intervention (surgical) ICU (Dec 2002-Dec 2007)

Control (medical) ICU (Jan 2005-Dec 2007)

24 ,124 0.69 (0.45-0.80)

19 18,402 0.59 (0.43-0.68)

NA NA

Daily bathing with chlorhexidine-based soap and the prevention of Staphylococcus aureus transmission and infection.

Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive ...
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