Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit

Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel.
Journal of Hospital Infection (Impact Factor: 2.78). 11/2007; 67(2):149-55. DOI: 10.1016/j.jhin.2007.07.023
Source: PubMed

ABSTRACT The prevalence of skin colonisation with Acinetobacter baumannii (ACBA) on admission to the medical intensive care unit (MICU) was studied in an institution endemic for ACBA bloodstream infections (BSIs). The impact of 4% chlorhexidine gluconate (4% CG) whole-body washing on the patients' ACBA skin colonisation was also determined. A prospective cohort trial in a MICU during March 2002 to December 2003 was performed, with a comparison between the prevalence and incidence of ACBA-BSIs obtained after intervention and retrospectively. During the intervention period, ACBA skin-screening swabs were taken from all patients on admission and periodically until discharge. Patients underwent whole-body disinfection with 4% CG immediately after obtaining the initial cultures. Disinfection was carried out on a daily basis until discharge, regardless of colonisation status. Of the 320 patients at ward admission, 55 (17%) yielded ACBA. The prevalence of ACBA colonisation among the remaining MICU patients was 5.5% at 24h and 1% at 48h following the disinfection regimen (P=0.002, OR: 2.4). Following a second screen, 80% of colonised patients were decolonised. Prevalence of ACBA-BSIs decreased from 4.6 to 0.6 per 100 patients (P < or = 0.001; OR: 7.6) and incidence decreased from 7.8 to 1.25 (85% reduction). We conclude that daily whole-body disinfection with 4% CG significantly reduced ACBA skin colonisation. This regimen may be considered in addition to well-known infection control measures, particularly in institutions with endemic rates of multidrug-resistant ACBA-BSIs.

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    • "Total body washing and bathing with 4% chlorhexidine gluconate has been shown to be effective in reducing skin colonisation with multidrug-resistant micro-organisms, such as vancomycinresistant enterococci and carbapenem-resistant Acinetobacter spp. [4] [13] [14]. Skin washing with octenidine hydrochloride and 2- phenoxyethanol also appears to be effective in similar situations [15]. "
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