Impacts of a long-term programme of active surveillance and chlorhexidine baths on the clinical and molecular epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) in an Intensive Care Unit in Scotland

Sangal, Vartul; Girvan, E. K.; Jadhav, Sagar A.; Lawes, Timothy; Robb, Andrew; Vali, Leila; Edwards, Giles; Yu, Jun; Gould, Ian M.

doi:10.1016/j.ijantimicag.2012.06.007

Cited by 17 publications

(10 citation statements)

References 30 publications

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“…Arguably this amounts to a non-intervention, as many patients will have died or been discharged by the time positive cultures were notified and barrier precautions implemented! In contrast to this ICU study, a similar intervention on a UK ICU, analysed by ITS, recently reported a 5-year follow-up on its original 2-year study and confirmed continuing success in controlling MRSA [11]. To the author's knowledge, this is the longest duration study of robust design in the literature.…”

Section: Recent Evidence On What Workmentioning

confidence: 58%

Controlling hospital MRSA

Gould

2013

Journal of Global Antimicrobial Resistance

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Recent evidence from publications describing the success of interventions to control hospital meticillin-resistant Staphylococcus aureus (MRSA), often in the endemic setting, is reviewed. Overall, there is cautious ground for optimism that MRSA can be controlled in a cost-effective manner by employing a bundle approach, the mainstay of which is widespread admission screening to inform patient-specific control measures.

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Section: Recent Evidence On What Workmentioning

confidence: 58%

Controlling hospital MRSA

Gould

2013

Journal of Global Antimicrobial Resistance

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“…Additionally, in a bench study of MRSA isolated over 4 years in a setting that used 4% CHG bathing, researchers found no detectable loss of antibiotic effectiveness or increase in MRSA resistance or infection with other organisms. 33 Using washcloths impregnated with 2% CHG ($5.52 per bath) would be 74% more expensive than our CHG soap and bath basin method ($3.18 per bath; Figure 2). Ritz et al 13 reported that a bath basin protocol was $2.50 less than cloths impregnated with 2% CHG. To translate the magnitude of this cost difference, the 41376 CHG-in-water Using prepackaged CHG wipes ($5.52 per bath) was 74% more expensive than using the CHG soap and bath method ($3.18 per bath).…”

Section: Discussionmentioning

confidence: 98%

Chlorhexidine Gluconate Bathing to Reduce Methicillin-Resistant Staphylococcus aureus Acquisition

Petlin

Schallom

Prentice

et al. 2014

Critical Care Nurse

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This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Discuss current research on chlorhexidine gluconate (CHG) bathing 2. Compare use of CHG-impregnated washcloths with CHG solution dissolved in bath water 3. Describe the effects of CHG bathing on methicillin-resistant Staphylococcus aureus BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism causing substantial morbidity and mortality in intensive care units. Chlorhexidine gluconate, a topical antiseptic solution, is effective against a wide spectrum of gram-positive and gram-negative bacteria, including MRSA. OBJECTIVES To examine the impact of a bathing protocol using chlorhexidine gluconate and bath basin management on MRSA acquisition in 5 adult intensive care units and to examine the cost differences between chlorhexidine bathing by using the bath-basin method versus using prepackaged chlorhexidineimpregnated washcloths. METHODS The protocol used a 4-oz bottle of 4% chlorhexidine gluconate soap in a bath basin of warm water. Patients in 3 intensive care units underwent active surveillance for MRSA acquisition; patients in 2 other units were monitored for a new positive culture for MRSA at any site 48 hours after admission. RESULTS Before the protocol, 132 patients acquired MRSA in 34 333 patient days (rate ratio, 3.84). Afterwards, 109 patients acquired MRSA in 41 376 patient days (rate ratio, 2.63). The rate ratio difference is 1.46 (95% CI, 1.12-1.90; P = .003). The chlorhexidine soap and bath basin method cost $3.18 as compared with $5.52 for chlorhexidine-impregnated wipes (74% higher). CONCLUSIONS The chlorhexidine bathing protocol is easy to implement, cost-effective, and led to decreased unit-acquired MRSA rates in a variety of adult intensive care units. (Critical Care Nurse. 2014;34[5] Reduction and elimination of hospital-acquired infections requires a multipronged approach. Hand hygiene is the primary strategy to reduce hospital-acquired infections and prevent transmission of resistant microbes between patients.5 Rapid reporting of culture results allows the health care team to initiate timely contact isolation precautions that help reduce the spread of infection once a resistant organism is identified. A multidisciplinary critical care team partnership with infection prevention specialists can facilitate these evidence-based prevention strategies. The increase in MRSA prevalence in the community and the high level of mortality associated with MRSA (3.62 deaths per 100000 population in the United States) 1 require clinicians to continuously explore measures to prevent MRSA acquisition in critically ill patients. MRSA colonization can be a source of fear, anxiety, and uncertainty for patients.6-8 Therefore, prevention of hospital-acquired MRSA is an important nursing intervention. Chlorhexidine gluconate (CHG), a topical antiseptic solution, is effective against a wide spectrum of grampositive and...

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“…These include the nurse and laboratory workload associated with screening, the delayed patient throughput during the hospital stay, decreased direct patient care contact hours with providers, social isolation due to fewer visitors, psychological effects (e.g., anger, depression, and anxiety), increased falls, electrolyte disturbances, and decubitus ulcers (9)(10)(11)25). Barrier nursing or isolation may also be logistically difficult secondary to a shortage of singlepatient rooms (3,4).…”

Section: Vertical Versus Horizontal Infection Control Strategies For mentioning

confidence: 99%

“…Just as hand hygiene is effective at reducing hands' polymicrobial burden, chlorhexidine is an effective agent against many bacterial pathogens and has been shown to decrease nosocomial infections with MRSA as well as other pathogens, reducing patient length of stay (31,32). Yet a study of 85 MRSA isolates in a Scottish ICU demonstrated no loss of efficacy or increase in resistance in MRSA in the setting of daily bed baths with 4% chlorhexidine gluconate: isolates exhibited stable minimum inhibitory concentrations to chlorhexidine over the 4 years of the study (4). One concern is that its daily use on oral, skin, or fomite surfaces (e.g., venous catheters) could select against resistant organisms.…”

Section: Maximizing Efficacy Of Horizontal Infection Control Measuresmentioning

confidence: 99%

Horizontal Infection Control Strategy Decreases Methicillin-Resistant Staphylococcus aureus Infection and Eliminates Bacteremia in a Surgical ICU Without Active Surveillance*

Traa

Barboza²,

Doron³

et al. 2014

Critical Care Medicine

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Impacts of a long-term programme of active surveillance and chlorhexidine baths on the clinical and molecular epidemiology of meticillin-resistant Staphylococcus aureus (MRSA) in an Intensive Care Unit in Scotland

Cited by 17 publications

References 30 publications

Controlling hospital MRSA

Controlling hospital MRSA

Chlorhexidine Gluconate Bathing to Reduce Methicillin-Resistant Staphylococcus aureus Acquisition

Horizontal Infection Control Strategy Decreases Methicillin-Resistant Staphylococcus aureus Infection and Eliminates Bacteremia in a Surgical ICU Without Active Surveillance*

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