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Chlorhexidine baths and Chlorhexidine baths and central line associated central line associated bloodstream infections bloodstream infections (CLABSIs)(CLABSIs)
L. Silvia Munoz-Price, MDAssociate Professor of Medicine University of Miami Miller School of MedicineMedical Director - Infection Control DepartmentJackson Memorial Hospital, Miami, FL
www.webbertraining.com
October 11, 2012
Teleclass Sponsored byHosted by Paul [email protected]
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Disclosures Disclosures Speaker for Sage Inc.
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OutlineOutlineBroad overview of chlorhexidineBio-burden of patient’s surfaces
(fecal patina)Sources of CLABSIsChlorhexidine baths for
prevention of CLABSIs◦Studies using impregnated cloths◦Studies using liquid chlorhexidine
Conclusions
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Chlorhexidine gluconateChlorhexidine gluconateLong acting topical antisepticIn use since 1954Water soluble Remains active for hours after
application
Milstone AM, et al. Clin Infec Dis 2008; 46:274-81Lio PA, Kaye E. Inf Dis Clin North Ame;
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Chlorhexidine gluconateChlorhexidine gluconateBinds to negatively charged
bacterial cell wall, causing osmotic changes and finally destroying the organism
Activity against: ◦Gram positive bacteria◦Gram negative bacteria ◦Yeast
No sporicidal activityMilstone AM, et al. Clin Infec Dis 2008; 46:274-81Lio PA, Kaye E. Inf Dis Clin North Ame;
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Chlorhexidine gluconateChlorhexidine gluconateFor skin antisepsis:
◦Reduction of bacterial skin burden◦Reduction of CLABSIs◦Reduction of acquisition of certain
resistant organismsPre-operative bathing and scrub Impregnated devices (vascular
catheters and dressings)Oropharynx antisepsis
Milstone AM, et al. Clin Infec Dis 2008; 46:274-81
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Main uses of chlorhexidine Main uses of chlorhexidine bathsbathsTo decrease CLABSIsTo decrease acquisition of
multidrug resistant organismsTo decrease surgical site
infections
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Fecal patina Fecal patina Stool organisms do not remain in
the stool but rather contaminate patient’s skin and the environment
This is known as fecal patina or fecal veneer
RA Weinstein. Crit Care Med 2012; 4: 1333-4Beezhold DW, et al. Clin Infect Dis 1997; 24:704-6
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Popovich KJ, et al. Infect Control Hosp Epidemiol 2012; 33: 889-896
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Popovich KJ, et al. Infect Control Hosp Epidemiol 2012; 33: 889-896
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Popovich KJ, et al. Infect Control Hosp Epidemiol 2012; 33: 889-896
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Why would chlorhexidine Why would chlorhexidine decrease CLABSIs?decrease CLABSIs?
Safdar N, Maki DG. Intensive Care Med 2004; 30:62-67
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LETS REVIEW THE LETS REVIEW THE LITERATURELITERATURE
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We will divide the studies We will divide the studies based on the preparation based on the preparation used:used:
Chlorhexidine impregnated cloths
Chlorhexidine solution
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STUDIES USING STUDIES USING CHLORHEXIDINE CHLORHEXIDINE IMPREGNATED CLOTHSIMPREGNATED CLOTHS
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Bleasdale SC, et al Arch Int Med 2007; 19: 2073-2077
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Bleasdale SC, et al Arch Int Med 2007; 19: 2073-2077
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Popovich KJ, et al. Infect Control Hosp Epidemiol 2009; 30:959-963
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Popovich KJ, et al. Infect Control Hosp Epidemiol 2009; 30:959-963
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Popovich KJ, et al. Intensive Care Med 2010; 36:854-858
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Popovich KJ, et al. Intensive Care Med 2010; 36:854-858
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Munoz-Price LS, et al. Crit Care Med. 2012 May;40(5):1464-9.
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PhasesPhasesPhase 1: Baseline
Phase 2: Scrub-the hub (chlorhexidine gluconate for 15 sec)
Phase 3: 2% chlorhexidine daily body baths AND scrub-the-hub
Phase 4: Daily ICU nursing rounds AND 2% CHG AND scrub-the-hub
26Munoz-Price LS, et al. Crit Care Med. 2012 May;40(5):1464-9.
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SICU TICU
NSICU
Munoz-Price LS, et al. Crit Care Med. 2012 May;40(5):1464-9.
LOOK ONLY AT THE SOLID LINE (MONTHLY CLABSI RATES)
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Evans HL, et al. Arch Surg 2010; 145: 240-246
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Evans HL, et al. Arch Surg 2010; 145: 240-246
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Montecalvo MA, et al. Am Journal Med 2012; 125:505-511
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Montecalvo MA, et al. Am Journal Med 2012; 125:505-511
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STUDIES USING STUDIES USING CHLORHEXIDINE CHLORHEXIDINE SOLUTIONSOLUTION
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Gould IM, et al. Int Journal Antimicrobial Agents 2007; 29: 536-543
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Climo MW, et al. Crit Care Med 2009; 37:1858- 1865
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Climo MW, et al. Crit Care Med 2009; 37:1858- 1865
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Climo MW, et al. Crit Care Med 2009; 37:1858- 1865
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Munoz-Price LS, et al. Infect Control Hosp Epidemiol 2009; 30:1031-35
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O’Horo JC, et al. Inf Control Hosp Epidemiol 2012; 33:257-267
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IMPLEMENTATION OF IMPLEMENTATION OF CHLORHEXIDINE BATHSCHLORHEXIDINE BATHSRemove all non-compatible
products from the units (soaps, lotions, skin barriers, etc)
In-service staff giving the bathsPersonally observe baths in a
regular basisQuantify the usage of the
product by the units
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CHALLENGES DURING CHALLENGES DURING IMPLEMENTATION OF IMPLEMENTATION OF CHLORHEXIDINECHLORHEXIDINEChlorhexidine doesn’t foamPersonnel perceives this lack of
foaming as lack of cleaningMixing with other products (soap
and water) might happen at the bedside, especially with liquid preparations
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ConclusionsConclusionsChlorhexidine baths constitute a
powerful tool to decrease CLABSIsPreparation of the inpatient units
should be done before instituting chlorhexidine baths
Frequent observations should occur after implementation in order to ensure compliance
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