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Relationship between chlorhexidine gluconate concentration and microbial colonization of patients’ skin

Published online by Cambridge University Press:  28 May 2024

Yoona Rhee
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
Andrew T. Simms
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
Michael Schoeny
Affiliation:
Department of Community, Systems and Mental Health Nursing, College of Nursing, Rush University Medical Center, Chicago, IL, USA
Arthur W. Baker
Affiliation:
Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
Meghan A. Baker
Affiliation:
Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
Shruti Gohil
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, CA, USA
Chanu Rhee
Affiliation:
Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, USA Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA, USA
Naasha J. Talati
Affiliation:
Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA, USA
David K. Warren
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA
Sharon Welbel
Affiliation:
Division of Infectious Diseases, Cook County Health, Chicago, IL, USA
Karen Lolans
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
Pamela B. Bell
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
Christine Fukuda
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
Mary K. Hayden
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
Michael Y. Lin*
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
*
Corresponding author: Michael Y. Lin; Email: michael_lin@rush.edu

Abstract

Objective:

To characterize the relationship between chlorhexidine gluconate (CHG) skin concentration and skin microbial colonization.

Design:

Serial cross-sectional study.

Setting/participants:

Adult patients in medical intensive care units (ICUs) from 7 hospitals; from 1 hospital, additional patients colonized with carbapenemase-producing Enterobacterales (CPE) from both ICU and non-ICU settings. All hospitals performed routine CHG bathing in the ICU.

Methods:

Skin swab samples were collected from adjacent areas of the neck, axilla, and inguinal region for microbial culture and CHG skin concentration measurement using a semiquantitative colorimetric assay. We used linear mixed effects multilevel models to analyze the relationship between CHG concentration and microbial detection. We explored threshold effects using additional models.

Results:

We collected samples from 736 of 759 (97%) eligible ICU patients and 68 patients colonized with CPE. On skin, gram-positive bacteria were cultured most frequently (93% of patients), followed by Candida species (26%) and gram-negative bacteria (20%). The adjusted odds of microbial recovery for every twofold increase in CHG skin concentration were 0.84 (95% CI, 0.80–0.87; P < .001) for gram-positive bacteria, 0.93 (95% CI, 0.89–0.98; P = .008) for Candida species, 0.96 (95% CI, 0.91–1.02; P = .17) for gram-negative bacteria, and 0.94 (95% CI, 0.84–1.06; P = .33) for CPE. A threshold CHG skin concentration for reduced microbial detection was not observed.

Conclusions:

On a cross-sectional basis, higher CHG skin concentrations were associated with less detection of gram-positive bacteria and Candida species on the skin, but not gram-negative bacteria, including CPE. For infection prevention, targeting higher CHG skin concentrations may improve control of certain pathogens.

Type
Original Article
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

These data were presented in part at the SHEA Spring 2019 Conference in Boston, Massachusetts, and at IDWeek 2019 in Washington, DC.

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