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Chlorhexidine baths and central line associated bloodstream infections (CLABSIs)

Chlorhexidine baths and central line associated bloodstream infections (CLABSIs). L. Silvia Munoz-Price, MD Associate Professor of Medicine University of Miami Miller School of Medicine Medical Director - Infection Control Department Jackson Memorial Hospital, Miami, FL.

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Chlorhexidine baths and central line associated bloodstream infections (CLABSIs)

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  1. Chlorhexidine baths and central line associated bloodstream infections (CLABSIs) L. Silvia Munoz-Price, MD Associate Professor of Medicine University of Miami Miller School of Medicine Medical Director - Infection Control Department Jackson Memorial Hospital, Miami, FL Teleclass Sponsored by Hosted by Paul Webber paul@webbertraining.com www.webbertraining.com October 11, 2012

  2. Disclosures • Speaker for Sage Inc.

  3. Outline • Broad overview of chlorhexidine • Bio-burden of patient’s surfaces (fecal patina) • Sources of CLABSIs • Chlorhexidine baths for prevention of CLABSIs • Studies using impregnated cloths • Studies using liquid chlorhexidine • Conclusions

  4. Chlorhexidine gluconate • Long acting topical antiseptic • In use since 1954 • Water soluble • Remains active for hours after application Milstone AM, et al. Clin Infec Dis 2008; 46:274-81 Lio PA, Kaye E. Inf Dis Clin North Ame;

  5. Chlorhexidine gluconate • Binds 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 activity Milstone AM, et al. Clin Infec Dis 2008; 46:274-81 Lio PA, Kaye E. Inf Dis Clin North Ame;

  6. Chlorhexidine gluconate • For skin antisepsis: • Reduction of bacterial skin burden • Reduction of CLABSIs • Reduction of acquisition of certain resistant organisms • Pre-operative bathing and scrub • Impregnated devices (vascular catheters and dressings) • Oropharynx antisepsis Milstone AM, et al. Clin Infec Dis 2008; 46:274-81

  7. Main uses of chlorhexidine baths • To decrease CLABSIs • To decrease acquisition of multidrug resistant organisms • To decrease surgical site infections

  8. 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: 1333-4 Beezhold DW, et al. Clin Infect Dis 1997; 24:704-6

  9. Popovich KJ, et al. Infect Control Hosp Epidemiol 2012; 33: 889-896

  10. Popovich KJ, et al. Infect Control Hosp Epidemiol 2012; 33: 889-896

  11. Popovich KJ, et al. Infect Control Hosp Epidemiol 2012; 33: 889-896

  12. Why would chlorhexidine decrease CLABSIs? Safdar N, Maki DG. Intensive Care Med 2004; 30:62-67

  13. LETS REVIEW THE LITERATURE

  14. We will divide the studies based on the preparation used: • Chlorhexidine impregnated cloths • Chlorhexidine solution

  15. STUDIES USING CHLORHEXIDINE IMPREGNATED CLOTHS

  16. Bleasdale SC, et al Arch Int Med 2007; 19: 2073-2077

  17. Bleasdale SC, et al Arch Int Med 2007; 19: 2073-2077

  18. Popovich KJ, et al. Infect Control Hosp Epidemiol 2009; 30:959-963

  19. Popovich KJ, et al. Infect Control Hosp Epidemiol 2009; 30:959-963

  20. Popovich KJ, et al. Intensive Care Med 2010; 36:854-858

  21. Popovich KJ, et al. Intensive Care Med 2010; 36:854-858

  22. Munoz-Price LS, et al. Crit Care Med. 2012 May;40(5):1464-9.

  23. Phases • Phase 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 Munoz-Price LS, et al. Crit Care Med. 2012 May;40(5):1464-9.

  24. SICU TICU NSICU LOOK ONLY AT THE SOLID LINE (MONTHLY CLABSI RATES) Munoz-Price LS, et al. Crit Care Med. 2012 May;40(5):1464-9.

  25. Evans HL, et al. Arch Surg 2010; 145: 240-246

  26. Evans HL, et al. Arch Surg 2010; 145: 240-246

  27. Montecalvo MA, et al. Am Journal Med 2012; 125:505-511

  28. Montecalvo MA, et al. Am Journal Med 2012; 125:505-511

  29. STUDIES USING CHLORHEXIDINE SOLUTION

  30. Gould IM, et al. Int Journal Antimicrobial Agents 2007; 29: 536-543

  31. Climo MW, et al. Crit Care Med 2009; 37:1858- 1865

  32. Climo MW, et al. Crit Care Med 2009; 37:1858- 1865

  33. Climo MW, et al. Crit Care Med 2009; 37:1858- 1865

  34. Munoz-Price LS, et al. Infect Control Hosp Epidemiol 2009; 30:1031-35

  35. O’Horo JC, et al. Inf Control Hosp Epidemiol 2012; 33:257-267

  36. IMPLEMENTATION OF CHLORHEXIDINE BATHS • Remove all non-compatible products from the units (soaps, lotions, skin barriers, etc) • In-service staff giving the baths • Personally observe baths in a regular basis • Quantify the usage of the product by the units

  37. CHALLENGES DURING IMPLEMENTATION OF CHLORHEXIDINE • Chlorhexidine doesn’t foam • Personnel perceives this lack of foaming as lack of cleaning • Mixing with other products (soap and water) might happen at the bedside, especially with liquid preparations

  38. Conclusions • Chlorhexidine baths constitute a powerful tool to decrease CLABSIs • Preparation of the inpatient units should be done before instituting chlorhexidine baths • Frequent observations should occur after implementation in order to ensure compliance

  39. 18 October (South Pacific Teleclass) Meningococcal Disease and the New Zealand Experience – Where to From Here Speaker: Dr. Tony Walls, University of Otago, New Zealand 30 October (British Teleclass) Reduce, Reuse, Recycle – Implications for Infection Prevention and ControlSpeaker: Dr. Andrew Nichols, Plymouth University, UK1 November Current Trends and Infection Prevention Issues in Healthcare Laundry Speaker: Prof. Lynne Sehulster, CDC Division of Healthcare Quality Promotion 8 November Surface Disinfection and Microbial Resistance Speaker: Prof. Markus Dettenkofer, University of Freiburg, Germany Teleclass sponsored by Diversey (www.diversey.com) 15 November Human Waste Disposal – Assessing the Risks of Differing Management Solutions

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