Chlorhexidine Gluconate to Cleanse Patients in a Medical Intensive Care Unit: The Effectiveness of Source Control to Reduce the Bioburden of Vancomycin-Resistant Enterococci | Critical Care Medicine | JAMA Internal Medicine | JAMA Network
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Original Investigation
February 13, 2006

Chlorhexidine Gluconate to Cleanse Patients in a Medical Intensive Care Unit: The Effectiveness of Source Control to Reduce the Bioburden of Vancomycin-Resistant Enterococci

Author Affiliations

Author Affiliations: Department of Medicine, Stroger (Cook County) Hospital, Chicago, Ill (Drs Vernon, Trick, and Weinstein and Mr Hayes); and Department of Medicine, Rush Medical College, Chicago (Drs Hayden and Weinstein and Mr Blom).

Arch Intern Med. 2006;166(3):306-312. doi:10.1001/archinte.166.3.306

Background  Historically, methods of interrupting pathogen transmission have focused on improving health care workers' adherence to recommended infection control practices. An adjunctive approach may be to use source control (eg, to decontaminate patients' skin).

Methods  We performed a prospective sequential-group single-arm clinical trial in a teaching hospital's medical intensive care unit from October 2002 to December 2003. We bathed or cleansed 1787 patients and assessed them for acquisition of vancomycin-resistant enterococci (VRE). We performed a nested study of 86 patients with VRE colonization and obtained culture specimens from 758 environmental surfaces and 529 health care workers' hands. All patients were cleansed daily with the procedure specific to the study period as follows: period 1, soap and water baths; period 2, cleansing with cloths saturated with 2% chlorhexidine gluconate; and period 3, cloth cleansing without chlorhexidine. We measured colonization of patient skin by VRE, health care worker hand or environmental surface contamination by VRE, and patient acquisition of VRE rectal colonization.

Results  Compared with soap and water baths, cleansing patients with chlorhexidine-saturated cloths resulted in 2.5 log10 less colonies of VRE on patients' skin and less VRE contamination of health care workers' hands (risk ratio [RR], 0.6; 95% confidence interval [CI], 0.4-0.8) and environmental surfaces (RR, 0.3; 95% CI, 0.2-0.5). The incidence of VRE acquisition decreased from 26 colonizations per 1000 patient-days to 9 per 1000 patient-days (RR, 0.4; 95% CI, 0.1-0.9). For all measures, effectiveness of cleansing with nonmedicated cloths was similar to that of soap and water baths.

Conclusion  Cleansing patients with chlorhexidine-saturated cloths is a simple, effective strategy to reduce VRE contamination of patients' skin, the environment, and health care workers' hands and to decrease patient acquisition of VRE.