Relation of Chlorhexidine Gluconate Skin Concentration to Microbial Density on Skin of Critically Ill Patients Bathed Daily with Chlorhexidine Gluconate

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Popovich, Kyle J ; Lyles, Rosie ; Hayes, Robert ; Hota, Bala ; Trick, William ; Weinstein, Robert A ; Hayden, Mary K
• Description:
  Introduction
  
  Previous work has shown that daily skin cleansing with chlorhexidine gluconate (CHG) is effective in preventing infection in the medical intensive care unit (MICU).
  
  Methods
  
  A colorimetric, semi-quantitative indicator was used to measure CHG concentration on skin (neck, antecubital fossae, inguinal areas) of patients bathed daily with CHG during MICU stay and after discharge from MICU, when CHG bathing stopped. Skin sites were also cultured quantitatively. The relationship between CHG concentration and microbial density on skin was explored in a mixed effects model using gram-positive colony forming unit (CFU) counts.
  
  Results
  
  For 20 MICU patients studied (240 measurements), lowest CHG concentrations (0–18.75μg/mL) and highest gram-positive CFUs were on the neck (median 1.07log10CFU, p=0.014). CHG concentration increased post-bath and decreased over 24h(p<0.001). In parallel, median log10CFUs decreased pre- to post-bath (0.78 to 0) and then increased over 24h to baseline of 0.78 (p=0.001). A CHG concentration >18.75μg/mL was associated with decreased gram-positive CFU(p=0.004). In all but 2 instances, CHG was detected on patient skin during entire inter-bath (~24h) period (18/20(90%) patients). In 11 patients studied after MICU discharge (80 measurements), CHG skin concentrations fell below effective levels after 1–3 days.
  
  Conclusion
  
  In MICU patients bathed daily with CHG, CHG concentration was inversely associated with microbial density on skin; residual antimicrobial activity on skin persisted up to 24h. Determination of CHG concentration on patients’ skin may be useful in monitoring adequacy of skin cleansing by healthcare workers.
  
  
• Subjects:
  Aged Anti-Infective Agents, Local Bacterial Load Baths Catheter-Related Infections Chlorhexidine Cohort Studies Cross Infection Female Gram-Positive Bacteria Humans Infection Control Intensive Care Units Male Middle Aged Models, Statistical Skin Skin Care Time Factors

  More +
• Source:
  Infect Control Hosp Epidemiol. 33(9):889-896.
• Pubmed ID:
  22869262
• Pubmed Central ID:
  PMC3632447
• Document Type:
  Journal Article
• Funding:
  K23 AI085029/AI/NIAID NIH HHS/United States ; U54 CK000161/CK/NCEZID CDC HHS/United States ; K23AI085029/AI/NIAID NIH HHS/United States
• Volume:
  33
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:f78e1bc799b938665e2bb658fea8add6418d3b1387a6c420140cc50d55d42ef4
• Download URL:
  https://stacks.cdc.gov/view/cdc/41887/cdc_41887_DS1.pdf
• File Type:
  [PDF - 821.27 KB ]