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

Borer, Abraham; Gilad, Jacob; Porat, Nurith; Megrelesvilli, R.; Saidel-Odes, Lisa; Peled, Nechama; Eskira, Seada; Schlaeffer, Francisc; Almog, Yaniv

doi:10.1016/j.jhin.2007.07.023

Cited by 56 publications

(49 citation statements)

References 25 publications

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“…Seventeen percent of patents were colonized with Acinetobacter baumannii on admission, 5.5% at 24 h, and 1% at 48 h (P ϭ 0.002). The prevalence of Acinetobacter baumannii BSIs decreased from 4.6 to 0.6 per 100 patients, and the incidence decreased from 7.6 to 1.25 (85% reduction) (108).…”

Section: Topical Agents Topical Chlorhexidine Gluconatementioning

confidence: 91%

Decolonization in Prevention of Health Care-Associated Infections

2016

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SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused onS. aureusdecolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent forS. aureusnasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well asCandida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

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Section: Topical Agents Topical Chlorhexidine Gluconatementioning

confidence: 91%

Decolonization in Prevention of Health Care-Associated Infections

2016

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“…[1][2][3][4][5] However, there is insufficient evidence for daily chlorhexidine bathing to reduce nosocomial spread of CRAB in endemic situations. 6,7 Also, some nonfermenting gram-negative organisms may be resistant to chlorhexidine. [8][9][10] Therefore, we investigated whether daily chlorhexidine bathing could prevent the acquisition of CRAB in a medical ICU with CRAB endemicity.…”

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confidence: 99%

Effect of daily chlorhexidine bathing on acquisition of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit with CRAB endemicity

Chung

Kim

Lee

et al. 2015

American Journal of Infection Control

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“…This is of importance, as A. baumannii is able to colonize the skin (2,7,8,17,24), which can be a source of infection and spread to other patients and the environment. Recent papers have emphasized the benefits of skin disinfection as a tool to reduce colonization pressure in a ward (2,12,22). Our main conclusion is based on the following findings.…”

Section: Discussionmentioning

confidence: 99%

Three-Dimensional Human Skin Equivalent as a Tool To Study Acinetobacter baumannii Colonization

Breij

Haisma

Rietveld

et al. 2012

Antimicrob Agents Chemother

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bAcinetobacter baumannii can colonize body surfaces of hospitalized patients. From these sites, invasion into the host and spread to other patients and the hospital environment may occur. The eradication of the organism from the patient's skin is an important infection control strategy during epidemic and endemic episodes. In this study, a three-dimensional (3D), air-exposed human epidermal skin equivalent was exploited to study Acinetobacter skin colonization. We characterized the adherence of A. baumannii ATCC 19606T and Acinetobacter junii RUH2228 T to and biofilm formation on the skin equivalent and the responses to these bacteria. Furthermore, we assessed the ability of the disinfectant chlorhexidine to decolonize the skin equivalents. The results revealed that both strains replicated on the stratum corneum for up to 72 h but did not invade the epidermis. A. baumannii, in contrast to A. junii, formed large biofilms on the stratum corneum. Bacterial colonization did not affect keratinocyte activation, proliferation, or differentiation, nor did it induce a strong inflammatory response. Disinfection with chlorhexidine solution resulted in complete eradication of A. baumannii from the skin, without detrimental effects. This 3D model is a promising tool to study skin colonization and to evaluate the effects of novel disinfectant and antimicrobial strategies. Multidrug-resistant (MDR) strains of Acinetobacter baumannii are notorious for their association with outbreaks of colonization and infection worldwide (6, 23). During such outbreaks, A. baumannii can colonize body surfaces of severely ill patients, from where the organisms may invade the patient, causing infection and/or spread to other patients and their environment. Thus, the skin is thought to constitute an important reservoir for A. baumannii during outbreaks and endemic episodes (1, 17). Insight into Acinetobacter skin colonization and the microbial ecology of the skin may result in novel strategies to prevent or interfere with skin colonization and thus contribute to the eradication of the organisms from a ward.Adherence to and biofilm formation on plastic and adherence to human cells are widely used systems to study the interactions of bacteria with abiotic and biotic surfaces. However, these systems may not adequately reflect the association of bacteria with the human skin, a process that takes place under relatively dry conditions (20). Moreover, adherence and subsequent replication are strongly influenced by environmental conditions (19), which in turn can be expected to depend on the physicochemical barrier properties of the skin surface and its nutrient availability. Once bacteria have adhered to the skin, they may invade the epidermis and trigger an inflammatory response. To our knowledge, little is known about the possible response of human skin cells to Acinetobacter.Tissue-engineered, air-exposed human skin models are threedimensional (3D) systems that mimic the native skin to a high degree (10, 11). Such epidermal skin equivalents are gener...

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

Cited by 56 publications

References 25 publications

Decolonization in Prevention of Health Care-Associated Infections

Decolonization in Prevention of Health Care-Associated Infections

Effect of daily chlorhexidine bathing on acquisition of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit with CRAB endemicity

Three-Dimensional Human Skin Equivalent as a Tool To Study Acinetobacter baumannii Colonization

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