Chlorhexidine gluconate to cleanse patients in a medical intensive care unit - The effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci
Chlorhexidine gluconate to cleanse patients in a medical intensive care unit - The effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci
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DOI：
10.1001/archinte.166.3.306
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发表时间：
2006-02-13
影响因子：
--
通讯作者：
Weinstein, RA
中科院分区：
文献类型：
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作者：
Vernon, MO;Hayden, MK;Weinstein, RA
背景资料：从历史上看，中断病原体传播的方法集中在提高卫生保健工作者对推荐的感染控制实践的遵守。一种预防性的方法可能是使用源控制（例如，净化患者的皮肤）。方法：我们进行了前瞻性序贯组单臂临床试验，在教学医院的医疗重症监护室从2002年10月至2003年12月。我们对1787名患者进行了沐浴或清洁，并对他们进行了万古霉素耐药肠球菌（VRE）的评估。我们对86例VRE定植患者进行了巢式研究，并从758个环境表面和529名卫生保健工作者的手中获得了培养标本。所有患者每天使用研究期间特定的程序进行清洁，如下所示：第1阶段，肥皂和水浴;第2阶段，用2%葡萄糖酸氯己定饱和的布清洁;第3阶段，不使用氯己定的布清洁。我们测量了VRE对患者皮肤的定植、医护人员手部或环境表面的VRE污染，以及患者直肠获得的VRE定植。结果：与肥皂和水浴相比，用洗必泰饱和布清洁患者，患者皮肤上的VRE菌落减少2.5 log（10），医护人员手部的VRE污染减少（风险比[RR]，0.6; 95%置信区间[CI]，0.4-0.8）和环境表面（RR，0.3; 95% CI，0.2-0.5）。VRE获得的发生率从26例定植/1000患者-天降至9例定植/1000患者-天（RR，0.4; 95% CI，0.1-0.9）。对于所有的措施，清洁与非药用布的有效性是类似的肥皂和水baths.Conclusion：清洗患者洗必泰饱和布是一种简单，有效的策略，以减少VRE污染的患者的皮肤，环境，卫生保健工作者的手，并减少患者收购VRE。
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 log(10) 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.