Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-28T14:28:59.863Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevention of Bloodstream Infections by Use of Daily Chlorhexidine Baths for Patients at a Long-Term Acute Care Hospital

Published online by Cambridge University Press:  02 January 2015

L. Silvia Munoz-Price ,
Bala Hota ,
Alexander Stemer  and
Robert A. Weinstein
L. Silvia Munoz-Price*
Affiliation:
Medical Specialists, Munster, Indiana
Bala Hota
Affiliation:
Department of Medicine, John H. Stroger Jr. Hospital, andRush University Medical Center, Chicago, Illinois
Alexander Stemer
Affiliation:
Medical Specialists, Munster, Indiana
Robert A. Weinstein
Affiliation:
Department of Medicine, John H. Stroger Jr. Hospital, andRush University Medical Center, Chicago, Illinois
*
Jackson Memorial Hospital, Park Plaza West, Room L-302, 1611 NW 12th Avenue, Miami, FL 33134 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the effect of bathing patients with 2% chlorhexidine on the rates of central vascular catheter (CVC)–associated bloodstream infection (BSI) at a long-term acute care hospital (LTACH).

Design.

Quasi-experimental study.

Setting.

A 70-bed LTACH in the greater Chicago area.

Patients.

All consecutive patients admitted to the LTACH during the period from February 2006 to February 2008.

Methods.

For patients at the LTACH, daily 2% chlorhexidine baths were instituted during the period from September 2006 until May 2007 (ie, the intervention period). A preintervention period (in which patients were given daily soap-and-water baths) and a postintervention period (in which patients were given daily nonmedicated baths and weekly 2% chlorhexidine baths) were also observed. The rates of CVC-associated BSI and ventilator-associated pneumonia were analyzed for the intervention period and for the pre- and postintervention periods.

Results.

The rates of CVC-associated BSI were 9.5, 3.8, and 6.4 cases per 1,000 CVC-days during the preintervention, intervention, and postintervention periods, respectively. By the end of the intervention period, there was a net reduction of 99% in the CVC-associated BSI rate. No changes were seen in the rates of ventilator-associated pneumonia during the preintervention and intervention periods.

Conclusion.

Daily chlorhexidine baths appeared to be an effective intervention to reduce rates of CVC-associated BSI in an LTACH.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 11 , November 2009 , pp. 1031 - 1035
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Klevens, RM, Edwards, JR, Gaynes, RP. The impact of antimicrobial-resistant, health care–associated infections on mortality in the United States. Clin Infect Dis 2008;47:927–930.Google Scholar
2.Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:2073–2079.Google Scholar
3.Mimoz, O, Villeminey, S, Ragot, S, et al.Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care. Arch Intern Med 2007;167:2066–2072.CrossRefGoogle ScholarPubMed
4.Pronovost, P, Needham, D, Berenholtz, S, et al.An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355:2725–2732.CrossRefGoogle ScholarPubMed
5.Dematte D'Amico, JE, Donnelly, HK, Mutlu, GM, Feinglass, J, Jovanovic, BD, Ndukwu, IM. Risk assessment for inpatient survival in the long-term acute care setting after prolonged critical illness. Chest 2003;124:1039–1045.CrossRefGoogle ScholarPubMed
6.Scheinhorn, DJ, Chao, DC, Hassenpflug, MS, Gracey, DR. Post-ICU weaning from mechanical ventilation: the role of long-term facilities. Chest 2001;120(6 Suppl):482S–484S.CrossRefGoogle ScholarPubMed
7.Lusk, R, O'Bryan, L. Evaluation of critically ill patients for transfer to long-term acute-care facilities. Lippincotts Case Manag 2002;7:24–26.CrossRefGoogle ScholarPubMed
8.Seneff, MG, Wagner, D, Thompson, D, Honeycutt, C, Silver, MR. The impact of long-term acute-care facilities on the outcome and cost of care for patients undergoing prolonged mechanical ventilation. Crit Care Med 2000;28:342–350.CrossRefGoogle ScholarPubMed
9.Munoz-Price, L. S. Long-term acute care hospitals. Clin Infect Dis 2009;49:438–443.CrossRefGoogle Scholar
10.Wolfenden, LL, Anderson, G, Veledar, E, Srinivasan, A. Catheter-associated bloodstream infections in 2 long-term acute care hospitals. Infect Control Hosp Epidemiol 2007;28:105–106.Google Scholar
11.Yang, CM, Reinke, W. Feasibility and validity of International Classification of Diseases based case mix indices. BMC Health Serv Res 2006;6:125.CrossRefGoogle ScholarPubMed
12.Munoz-Price, LS, Hota, B, Nimon, N, et al.Effect of a ventilator-associated pneumonia (VAP) infection control bundle for the prevention of VAP in a long-term care acute hospital (LTACH). In: Program and abstracts of the 18th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America (Orlando). Arlington, VA: Society for Healthcare Epidemiology of America; 2008:134. Abstract 379.Google Scholar
13.Gould, CV, Rothenberg, R, Steinberg, JP. Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27:920–925.CrossRefGoogle ScholarPubMed
14.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
15.Shardell, M, Harris, AD, El-Kamary, SS, Furuno, JP, Miller, RR, Perencevich, EN. Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies. Clin Infect Dis 2007;45:901–907.Google Scholar
16.Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Blom, DW, Weinstein, RA; Chicago Antimicrobial Resistance Project (CARP). Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166:306–312.CrossRefGoogle Scholar
17.Romero-Gómez, MP, Quiles-Melero, MI, Peña García, P, et al.Outbreak of Burkholderia cepacia bacteremia caused by contaminated chlorhexidine in a hemodialysis unit. Infect Control Hosp Epidemiol 2008;29:377–378.CrossRefGoogle Scholar
18.Marschall, J, Mermel, LA, Classen, D, et al.Strategies to prevent central line–associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 2008;29(Suppl 1):S22–S30.CrossRefGoogle ScholarPubMed
19.Rosenthal, MB. Nonpayment for performance? Medicare's new reimbursement rule. N Engl J Med 2007;357:1573–1575.CrossRefGoogle ScholarPubMed