Chlorhexidine Bathing Strategies for Multidrug-Resistant Organisms: A Summary of Recent Evidence

Abstract

Objective The aim of the study was to summarize the latest evidence for patient bathing with a 2% to 4% chlorhexidine gluconate solution to reduce multidrug-resistant organism (MDRO) transmission and infection. Methods We searched 3 databases (CINAHL, MEDLINE, and Cochrane) for a combination of the key words “chlorhexidine bathing” and MeSH terms “cross-infection prevention,” “drug resistance, multiple, bacterial,” and “drug resistance, microbial.” Articles from January 1, 2008, to December 31, 2018, were included, as well as any key articles published after December 31. Results Our findings focused on health care–associated infections (HAIs) and 3 categories of MDROs: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Enterobacteriaceae (CRE). Chlorhexidine bathing reduces MRSA acquisition and carriage, but not all studies found significant reductions in MRSA infections. Several studies found that chlorhexidine bathing reduced VRE acquisition and carriage, and one study showed lower VRE infections in the bathing group. Two studies found that bathing reduced CRE carriage (no studies examined CRE infections). Two very large studies (more than 140,000 total patients) found bathing significantly reduced HAIs, but these reductions may be smaller when HAIs are already well controlled by other means. Conclusions There is a high level of evidence supporting chlorhexidine bathing to reduce MDRO acquisition; less evidence is available on reducing infections. Chlorhexidine bathing is low cost to implement, and adverse events are rare and resolve when chlorhexidine use is stopped. There is evidence of chlorhexidine resistance, but not at concentrations in typical use. Further research is needed on chlorhexidine bathing’s impact on outcomes, such as mortality and length of stay.

Chlorhexidine gluconate bathing of adult patients in intensive care units in São Paulo, Brazil: Impact on the incidence of healthcare-associated infection

“…Robert A. Weinstein was the first to study daily full body CHG bathing to prevent infections in ICUs. 11 It has been used in several settings to control outbreaks and infections related to MDROs including methicilin-resistant Staphylococcus aureus (MRSA) 12 vancomycin-resistant Enterococcus sp (VRE) 11 and Gran-negative bacteria 13 , 14 , 15 , 16 and fungi, 17 , 18 but has no activity against mycobacteria and bacterial spores. 19 , 20 …”

Management of Patients with Multidrug-Resistant Organisms in Outpatient Dialysis Facilities

“…The prevalence of patients with infections caused by multidrug-resistant organisms (MDROs) has dramatically increased across health care systems. MDROs represent a significant public health issue, 1 and outpatient dialysis centers are increasingly being called upon to accept and care for these patients.…”

“…MDROs are characterized by resistance to one or more classes of antimicrobials. 1 They are especially problematic because of their hardiness and endurance in the environment, high transmissibility, difficulty with detection, frequent asymptomatic colonization, and significant associated morbidity and mortality. 1 Once present, they are challenging and costly to eradicate, 2 increasing the risk of spread to other patients through environmental and staff contamination.…”

“…The recommended infection control interventions, physical environment changes, and pharmaceutical costs to care for patients with MDROs can be prohibitive and disruptive for dialysis facilities. 1,2 Management of patients with MDRO may necessitate altering patient and staff scheduling, limiting or eliminating the use of shared equipment and space, and at times even closure or suspension of new admissions. 2,12 These additional precautions are costly and impose additional staff demands, further exacerbating unprecedented labor shortages, supply cost inflation, and caregiver burnout.…”

“…9 Specific measures for management and treatment of infected patients vary by organism but may include isolation or cohorting, contact investigation and reporting, contact precautions, staff training and education, routine/active surveillance, dedicated staff, unique personal protective equipment requirements, augmented cleaning (Environmental Protection Agency list P or K), and extra disinfection of equipment (Table 1). 1,2,9,10 The Centers for Disease Control and Prevention has not published guidelines for the management of these patients in outpatient dialysis facilities. While it is common practice to extrapolate the same standards designed for acute care settings, these current recommendations are not uniformly transferable.…”