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

Infection Control and Hospital Epidemiology Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel.
Journal of Hospital Infection (Impact Factor: 2.54). 11/2007; 67(2):149-55. DOI: 10.1016/j.jhin.2007.07.023
Source: PubMed


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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    ABSTRACT: After a single patient was transferred to Leipzig University Hospital from a hospital in Rhodes, Greece, the hospital experienced the largest outbreak due to a KPC-2-producing Klebsiella pneumoniae (KPC-2-KP) strain thus far observed in Germany. Ninety patients hospitalised between July 2010 and October 2012 were affected. In an attempt to eliminate KPC-2-KP from their digestive tracts, 14 consecutive patients (16%) were treated with a short course (7 days) of selective digestive decontamination (SDD), employing colistin (1 million units q.i.d.) and gentamicin (80mg q.i.d.) as oral solutions, and applying colistin/gentamicin gel (0.5g) to the oral cavity. In a retrospective analysis, these 14 SDD patients were compared with the remaining 76 patients harbouring KPC-2-KP. KPC-2-KP carrier status was followed in all 14 SDD patients by submitting stool samples to KPC-specific PCR. The mean follow-up period was 48 days (range 12-103 days). Successful elimination of KPC-2-KP was defined as a minimum of three consecutive negative PCR test results separated by ≥48h each. Decolonisation of KPC-2-KP was achieved in 6/14 patients (43%) after a mean of 21 days (range 12-40 days), but was also observed in 23/76 (30%) of the non-SDD controls (P=0.102). SDD treatment resulted in the development of secondary resistance to colistin (19% increase in resistance rate) and gentamicin (45% increase) in post-treatment isolates. In the control group, no secondary resistance occurred. We conclude that the SDD protocol applied in this study was not sufficiently effective for decolonisation and was associated with resistance development.
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    • "Similarly, bed baths using soap and water did not significantly reduce levels of spores on the skin of patients with CDI [23]. Because effective hand hygiene and bathing interventions have been shown to reduce infections with other pathogens, there is an important unmet need for development of more effective strategies to reduce the burden of spores on skin [24–26]. "
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    • "Both studies reported very high rates of contamination following soap and water bathing. Other studies used an experimental design to compare the effect of chlorhexidine (saturated cloths or solution) with soap and water in reducing the prevalence of bacterial colonisation and infection rates in patients (Vernon et al., 2006; Kassakian et al., 2011; Bleasdale et al., 2007; Popovich et al., 2009, 2010; Munoz-Price et al., 2009; Evans et al., 2010; Dixon and Carver, 2010; Wendt et al., 2007; Climo et al., 2009; Borer et al., 2007). "
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    ABSTRACT: AIM: This paper describes a structured approach for documenting a search strategy, prior to the scholarly critique and review of the retrieved literature. BACKGROUND AND CONTEXT: There has been a shift in publication expectations when it comes to the presentation of a literature review, from the more traditional narrative review to a more systematic approach, following a specific framework. METHODS: This paper presents a 12 step framework for documenting the search strategy prior to undertaking a critique and synthesis of the retrieved literature. The authors provide a worked example about potential sources of cross contamination including hospital bath basins and soap and water bathing. DISCUSSION: An overview of the 12 step framework is presented. This includes step-by-step instructions on how to conduct and write a search strategy for a literature review. A number of resources available for creating reviews and critiquing reviews are referenced, but these are not exclusive. CONCLUSION: Reviews can be an important and valuable contribution when undertaken well, providing the reader with evidence of a clear structure. This paper provides a 12 step framework that will be of benefit to students, educationalists, and researchers required to embark on a review.
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