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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Acinetobacter baumannii is 1 of the most important nosocomial pathogens and the causative agent of numerous types of infections, especially in intensive care units (ICUs). Our aim was to evaluate the effect of 2% chlorhexidine gluconate (CHG) whole-body washing of ICU patients on A baumannii in a tertiary care hospital. Methods: During the 6-month intervention period, 327 patients were subjected to whole-body bath with 2% CHG-impregnated wipes. bla(IMP) (active on imipenem), bla(VIM) (Verona integron-encoded metallo-beta-lactamase), and bla(oxacillinase) (OXA) of A baumannii were typed. Isolates were genotyped by pulsed-field gel electrophoresis. Minimum inhibitory concentrations (MIC) to CHG were determined by the agar dilution method and drug susceptibility determined using the broth microdilution method. Biofilm formation was determined by crystal violet staining. Results: We analyzed 80 isolates during the baseline period and 69 isolates during the intervention period. There was a decrease in the MIC50 and MIC90 values for CHG for isolates (8 mg/L and 16 mg/L, respectively). All isolates typed positive for OXA(51-like) and 86% typed positive for OXA(24-like) pulsed-field gel electrophoresis identified 2 main clone types. During the intervention period the frequency of clone A decreased and that of clone B increased. Both clones were OXA(24-like) positive. Conclusions: The A baumannii isolates recovered from patients who received body washing with 2% CHG presented with a significant decrease in CHG MIC values associated with a change in clonality correlating with increased biofilm production. Copyright
    American Journal of Infection Control 06/2014; 42(8). DOI:10.1016/j.ajic.2014.04.009 · 2.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Infection is a major complication associated with combat-related injuries. Beside immobilization, wound irrigation, surgical debridement and delayed coverage, post-injury antimicrobials contribute to reduce combat-related infections, particularly those caused by bacteria of the early contamination flora. In modern warfare, bacteria involved in combat-related infections are mainly Gram-negative bacteria belonging to the late contamination flora. These bacteria are frequently resistant or multiresistant to antibiotics and spread through the deployed chain of care. This article exposes the principles of war wounds antimicrobial prophylaxis recommended in the French Armed Forces and highlights the need for high compliance to hygiene standard precautions, adapted contact precautions and judicious use of antibiotics in French deployed military medical treatment facilities (MTF).
    Travel Medicine and Infectious Disease 07/2014; 12(4). DOI:10.1016/j.tmaid.2014.04.013 · 1.54 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Skin is a major reservoir of bacterial pathogens in intensive care unit (ICU) patients. The aim of this study was to assess the skin bacterial richness and diversity in ICU patients and the effect of CHG daily bathing on skin microbiota. Twenty ICU patients were included during an interventional period with CHG daily bathing (n = 10) and a control period (n = 10). At day seven of hospitalization, eight skin swab samples (nares, axillary vaults, inguinal creases, manubrium and back) were taken from each patient. The bacterial identification was performed by microbial culturomics. We used the Shannon index to compare the diversity. We obtained 5,000 colonies that yielded 61 bacterial species (9.15 ± 3.7 per patient), including 15 (24.5 %) that had never been cultured from non-pathological human skin before, and three (4.9 %) that had never been cultured from human samples before. Notably, Gram-negative bacteria were isolated from all sites. In the water-and-soap group, there was a higher risk of colonization with Gram-negative bacteria (OR = 6.05, 95 % CI [1.67-21.90]; P = 0.006). In the CHG group, we observed more patients colonized by sporulating bacteria (9/10 vs. 3/10; P = 0.019) with a reduced skin bacterial richness (P = 0.004) and lower diversity (0.37, 95 % CI [0.33; 0.42] vs. 0.50, 95 % CI [0.48; 0.52]). Gram-negative bacteria are frequent and disseminated components of the transient skin flora in ICU patients. CHG daily bathing is associated with a reduction in Gram-negative bacteria colonization together with substantial skin microbiota shifts.
    European Journal of Clinical Microbiology 01/2015; 34(5). DOI:10.1007/s10096-015-2316-y · 2.54 Impact Factor