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Chlorhexidine reduces MRSA, VRE in patients with devices
SAN DIEGO — Daily universal bathing with chlorhexidine reduces the combination of MRSA and vancomycin-resistant enterococci in non-ICU hospital patients with medical devices, according to researchers.
However, it does not do so in all populations, they said.
“We found that, in general units outside the ICU, only patients with central lines and other medical devices derived a benefit from chlorhexidine bathing,” researcher Susan S. Huang, MD, MPH, from the University of California, Irvine School of Medicine, told Infectious Disease News.
Previous data gathered by Huang and colleagues showed that chlorhexidine bathing with nasal ointment decolonization greatly reduced infection in high-risk ICU patients.
In their follow-up study, they sought to test the effect on non-ICU patients in general, and then on higher-risk non-ICU patients with devices like central lines, midlines and lumbar drains. The researchers included a total of 194 adult units at 53 United States hospitals associated with Hospital Corporation of America In all, 189,616 patients were treated during the study’s baseline period from April 2013 to March 2014, and 340,350 were treated during the intervention period from June 2014 to February 2016.
Patients were randomly assigned to routine care or decolonization. The latter included either daily bathing with 2% chlorhexidine not to be rinsed off or showering with 4% chlorhexidine that was rinsed off. All patients with known MRSA also received mupirocin for 5 days.
The primary outcome was the presence of any MRSA and VRE clinical isolates attributable to the hospital unit. An important secondary outcome, Huang said, was all-cause bloodstream infection attributable to the unit.
The researchers found that decolonization reduced MRSA and VRE by 32% and all-cause bloodstream infections by 28% in patients with central lines or other medical devices. There was no significant difference in either outcome among other patients. In routine care, the mean number of unit-attributable MRSA and VRE isolates was 2.4 per 1,000 patient-days at baseline, compared with 2.1 per 1,000 patient-days after the intervention period. With decolonization, the mean number was 2.2 per 1,000 patient-days at baseline, compared with 1.7 per 1,000 patient-days after intervention (HR = 0.87 and 0.79, respectively, P = .16).
In routine care, the researchers found a mean of 1.3 unit-attributable all-cause bloodstream infections per 1,000 patient-days both at baseline and during the intervention, while decolonization yielded 1.3 per 1,000 patient-days at baseline and 1.2 per 1,000 patient-days after the intervention (HR = 0.97 and 0.89, respectively, P = .35).
Despite the lack of benefit to non-ICU patients in general, Huang said the results in those with devices were encouraging.
“We were pleased to find that patients with devices could be substantially protected from MRSA, VRE and serious bloodstream infections,” she said. “These patients make up approximately 10% of the non-ICU population, but they are responsible for 35% of MRSA and VRE and 59% of bloodstream infections in non-ICU patients.
“Decolonization with chlorhexidine should be used in non-ICU patients with central lines and devices. And if they are known to have MRSA or a history history of MRSA, they should receive nasal ointment.” – by Joe Green
Reference:
Huang SS, et al. Abstract 1000. Presented at: ID Week; Oct. 4-8, 2017, San Diego.
Disclosures: Huang reports that health care facilities included in the study received products from Sage Products, Xttrium Laboratories, Clorox, 3M and Molnlycke. Please see the study for all other authors’ relevant financial disclosures.