Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review.

Abstract

BACKGROUND:

The topical use of chlorhexidine gluconate (CHG) is intended to reduce bacterial density on patients' skin.

AIM:

To assess the impact of body bath or skin cleansing with CHG-impregnated or CHG-saturated washcloths in preventing healthcare-associated infections and colonization.

METHODS:

This systematic review included published randomized controlled trials, cross-over trials, cohort studies and before-and-after studies. Studies were included if they compared the use of CHG in washcloths with any of the following; soap and water bathing, routine advice, no intervention.

FINDINGS:

Sixteen published studies and four conference abstracts were included for systematic review. Nine studies reported the impact of CHG on incidence of central-line-associated bloodstream infection (CLABSI); the incidence rate ratio (IRR) was 0.43 [95% confidence interval (CI): 0.26-0.71]. Five studies assessed the impact of CHG washcloths on incidence of surgical site infection (SSI); the RR was 0.29 (95% CI: 0.17-0.49). Four studies reported the impact on vancomycin-resistant enterococci (VRE) colonization; the IRR was 0.43 (95% CI: 0.32-0.59). Three studies reported the impact on meticillin-resistant Staphylococcus aureus (MRSA) colonization rate; the IRR was 0.48 (95% CI: 0.24-0.95). Six studies reported the impact on VRE infection; the IRR was 0.90 (95% CI: 0.42-1.93). Six studies reported the impact on MRSA infection; the IRR was 0.82 (95% CI: 0.51-1.30). There was no reduction in acinetobacter infection rates in the three studies where this was reported.

CONCLUSION:

These results suggest that the use of non-rinse CHG application significantly reduces the risk of CLABSI, SSI and colonization with VRE or MRSA, but not infection.

• Authors: S Karki, A C Cheng
• Journal: The Journal of hospital infection (J Hosp Infect) Vol. 82 Issue 2 Pg. 71-84 (Oct 2012) ISSN: 1532-2939 [Electronic] England
• PMID: 22889522 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Disinfectants
• chlorhexidine gluconate
• Chlorhexidine

Topics

• Carrier State (epidemiology, microbiology, prevention & control)
• Catheter-Related Infections (epidemiology, microbiology, prevention & control)
• Chlorhexidine (administration & dosage, analogs & derivatives)
• Cross Infection (epidemiology, microbiology, prevention & control)
• Disinfectants (administration & dosage)
• Enterococcus (isolation & purification)
• Humans
• Incidence
• Methicillin-Resistant Staphylococcus aureus (isolation & purification)
• Risk Assessment
• Skin (microbiology)
• Vancomycin Resistance
• Wound Infection (epidemiology, microbiology, prevention & control)