Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand

Boonyasiri, Adhiratha; Thaisiam, Peerapat; Permpikul, Chairat; Judaeng, Tepnimitr; Suiwongsa, Bordeesuda; Apiradeewajeset, Napaporn; Fakthongphan, Teerawan; Suddee, Sunun; Laoagtipparos, Wandee; Thamlikitkul, Visanu

doi:10.1017/ice.2015.285

Cited by 43 publications

(47 citation statements)

References 26 publications

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“…Beneficial effects of disinfecting washing on the reduction of local multidrug-resistant colonization flora are considered as well established [13, 14], also leading to a reduced number of systemic infections [15]. In line with previous considerations [8], patient compliance was shown in our investigation to play a significant role in terms of the effectiveness of disinfection-based local decolonization procedures.…”

Section: Discussionsupporting

confidence: 75%

Colonization with multidrug-resistant bacteria — on the efficiency of local decolonization procedures

Münch

Hagen

Müller

et al. 2017

EuJMI

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The effectiveness of a disinfectant-based decolonization strategy for multidrug-resistant bacteria like extended spectrum β-lactamase (ESBL)-positive Gram-negative bacteria with or without additional fluoroquinolon and carbapenem resistance as well as vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus was assessed.Between 2011 and 2015, 25 patients from Libya, Syria, and the Ukraine with war traumata were treated at the Bundeswehr hospital Hamburg. The patients were heavily colonized and infected with multidrug-resistant bacteria, altogether comprising 371 distinct combinations of pathogens and isolation sites. Local disinfection was assessed for effectiveness regarding successful decolonization of multidrug-resistant bacteria.Altogether, 170 cases of successful decolonization were observed, comprising 95 (55.8%) such events at sampling sites that were accessible to disinfecting procedures. The remaining 75 (44.2%) decolonization events had to be considered as spontaneous. In contrast, 95 out of 172 (55.2%) colonized isolation sites that were accessible to disinfection procedures were successfully decolonized. Patient compliance with the enforced hygiene procedures was associated with decolonization success. Systemic antibiotic therapy did not relevantly affect isolation time.Disinfecting washing moderately supports local decolonization of multidrug-resistant pathogens in comparison with spontaneous decolonization rates if the patients’ compliance with the applied hygiene procedures is ensured.

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Section: Discussionsupporting

confidence: 75%

Colonization with multidrug-resistant bacteria — on the efficiency of local decolonization procedures

Münch

Hagen

Müller

et al. 2017

EuJMI

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“…Surgical incisions and entry portals for open, mini-open, and arthroscopic RCR are near the axilla, which may increase the possibility of inadvertent transmission of colonized microorganisms into the joint during surgery. Furthermore, precautions, such as clipping the axillary hair or preparing axillary skin with various solutions have not been proven to be successful in reducing infection rates or bacterial load[ 15 , 16 ].…”

Section: Risk Factorsmentioning

confidence: 99%

Postoperative deep shoulder infections following rotator cuff repair

Ateşok

MacDonald

Leiter

et al. 2017

WJO

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Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most commonly isolated pathogens are Propionibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. Management of a deep soft-tissue infection of the shoulder after RCR involves surgical debridement with lavage and long-term intravenous antibiotic treatment based on the pathogen identified. Although deep shoulder infection after RCR is usually successfully treated, complications of this condition can be devastating. Prolonged course of intravenous antibiotic treatment, extensive soft-tissue destruction and adhesions may result in substantially diminished functional outcomes.

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“…In addition, it is unclear whether consistent results will be achieved with all types of hospitalcreated CHG baths. For example, a study by Boonyasiri et al (22) in Thailand created 2% CHG-impregnated washcloths in the hospital pharmacy, internally analyzed CHG concentration, and performed in vitro testing every few weeks of microbiologic activity yet did not demonstrate a significant decline in HAIs in their study; it is unclear the extent to which the hospital made CHG cloths impacted the results of this study which was conducted in a setting with a high prevalence of multi-drug resistant gramnegative colonization. Prior to facilities forgoing CHGimpregnated cloths for a less expensive solution (23), quality checks should be instituted to ensure the appropriate concentration of CHG and proper application of baths.…”

mentioning

confidence: 92%

Another look at CHG bathing in a surgical intensive care unit

Popovich¹

2017

Ann. Transl. Med.

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Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand

Abstract: The effectiveness of 2% chlorhexidine-impregnated washcloths for the prevention of MDR gram-negative bacteria colonization and hospital-acquired infection in adult patients in ICU was not proven. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01989416.

Cited by 43 publications

References 26 publications

Colonization with multidrug-resistant bacteria — on the efficiency of local decolonization procedures

Colonization with multidrug-resistant bacteria — on the efficiency of local decolonization procedures

Postoperative deep shoulder infections following rotator cuff repair

Another look at CHG bathing in a surgical intensive care unit

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