Relationship between chlorhexidine gluconate skin concentration and microbial density on the skin of critically ill patients bathed daily with chlorhexidine gluconate.
Relationship between chlorhexidine gluconate skin concentration and microbial density on the skin of critically ill patients bathed daily with chlorhexidine gluconate.
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DOI：
10.1086/667371
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发表时间：
2012-09
影响因子：
4.5
通讯作者：
Hayden MK
中科院分区：
文献类型：
--
作者：
Popovich KJ;Lyles R;Hayes R;Hota B;Trick W;Weinstein RA;Hayden MK
先前的研究表明，在医疗重症监护病房（MICU）中，每天用葡萄糖酸氯己定（CHG）清洁皮肤可以有效预防感染。使用比色半定量指示剂测量在 MICU 住院期间以及从 MICU 出院后停止 CHG 沐浴时每天使用 CHG 沐浴的患者皮肤（颈部、肘前窝、腹股沟区域）上的 CHG 浓度。皮肤部位也进行了定量培养。使用革兰氏阳性菌落形成单位 (CFU) 计数在混合效应模型中探讨 CHG 浓度与皮肤微生物密度之间的关系。对于研究的 20 名 MICU 患者（240 次测量），最低的 CHG 浓度（0-18.75μg/mL）和最高的革兰氏阳性 CFU 位于颈部（中位值 1.07log10CFU，p=0.014）。 CHG 浓度在沐浴后增加并在 24 小时内下降（p<0.001）。与此同时，浴前和浴后的 log10CFU 中位数下降（0.78 至 0），然后在 24 小时内增加至基线 0.78（p=0.001）。 CHG 浓度 >18.75μg/mL 与革兰氏阳性菌 CFU 降低相关（p=0.004）。除 2 例外，在所有情况下，在整个沐浴间（约 24 小时）期间（18/20（90%）患者）在患者皮肤上检测到 CHG。在 MICU 出院后研究的 11 名患者中（80 次测量），CHG 皮肤浓度在 1-3 天后降至有效水平以下。在每天用 CHG 沐浴的 MICU 患者中，CHG 浓度与皮肤上的微生物密度呈负相关；皮肤上的残留抗菌活性可持续长达 24 小时。测定患者皮肤上的 CHG 浓度可能有助于监测医护人员的皮肤清洁是否充分。
Previous work has shown that daily skin cleansing with chlorhexidine gluconate (CHG) is effective in preventing infection in the medical intensive care unit (MICU). 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. 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. 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.
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影响因子：
--
作者：
Vernon, MO;Hayden, MK;Weinstein, RA
通讯作者：
Weinstein, RA
影响因子：
4.5
作者：
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通讯作者：
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DOI：
10.1016/j.jamcollsurg.2007.12.054
发表时间：
2008-08-01
影响因子：
5.2
作者：
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通讯作者：
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影响因子：
5.7
作者：
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通讯作者：
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影响因子：
8.8
作者：
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通讯作者：
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