1816. Chlorhexidine (CHG) Concentration on the Skin Following Home Application Among Patients Enrolled in a Clinical Trial of MRSA Decolonization Post-Hospital Discharge
Session: Oral Abstract Session: Addressing Healthcare-Associated MRSA Outside of the Inpatient Setting
Saturday, October 5, 2013: 2:45 PM
Room: The Moscone Center: 200-212

Background: MRSA carriers are at high risk for subsequent MRSA infection, particularly during and following hospitalization. Skin decolonization with CHG is increasingly used to prevent infection. We evaluated skin concentrations of CHG within 24 hours of reported application at home.

 

Methods: Among patients enrolled in an ongoing randomized trial of post-discharge decolonization, we took biceps and abdominal skin swabs of patients who reported applying 4% CHG within 24 hours of a scheduled trial visit. Patients were instructed to achieve a 2 minute out-of water CHG contact time prior to rinsing by shower or bath. CHG on skin swabs was measured by a semi-quantitative, colorimetric assay. CHG positivity was assessed by days of application and hours since last application. We compared MRSA skin cultures taken from axillary/groin sites at the time of the CHG swab and prior to decolonization.  The MIC of CHG was determined by broth microdilution for a sample of MRSA isolates.

                            

Results: Among the 107 adults who reported CHG use in the prior 24 hours, 86% had detectable CHG at ≥1 skin site; median concentration detected was 19.5 mcg/ml (range 4.9-625). CHG was detected on the abdomen in 76% of subjects (median = 19.5 mcg/ml, range 4.9-312.5) and on the biceps in 73% (median = 19.5 mcg/ml, range 4.9-625). Maximum CHG concentration on either biceps or abdominal skin did not correlate with time since shower (Figure) or days of CHG. MRSA was detected in axillary/groin cultures in 29% (N=31) prior to decolonization and 7.5% (N=8) at the time of CHG assessment. Of the 8 who remained MRSA+, 7 had no detectable CHG on either abdominal or biceps skin. Among those without detected CHG, 40% (6/15) had MRSA+ skin cultures at the time of the swab vs 2.2% (2/92) with detectable CHG, p<0.001). We did not detect an increase in CHG MICs in a sample of pre- and post-decolonization strains (median MIC = 2 mcg/ml, range 2-4).

 

 

Conclusion: CHG is measurable on the skin in most patients within 24 hours of a reported post-discharge 4% CHG self-application with rinsing and is strongly associated with reduced MRSA carriage on skin. Many MRSA+ patients can adequately perform home CHG application and CHG is effective in decreasing skin carriage in this population.

 

 

 

Susan S. Huang, MD, MPH, FIDSA1, Loren Miller, MD, MPH2, Adrijana Gombosev, BS1, Lena M Portillo, BS3, Karen Lolans-Mazza, BS4, Raveena D Singh, MPH1, Diane Kim, BS1, Eric Cui, BS1, Samantha J. Eells, MPH2, James A. Mckinnell, MD5 and Mary K Hayden, MD, FSHEA, FIDSA6, (1)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, (2)Division of Adult Infectious Diseases, Los Angeles Biomedical Research Institute At Harbor-UCLA Medical Center, Torrance, CA, (3)Rush University Medical Center, Chicago, IL, (4)Rush Univ. Med. Ctr., Chicago, IL, (5)La Biomed At Harbor-UCLA & Torrance Memorial, Torrance, CA, (6)Internal Medicine, Rush University Medical Center, Chicago, IL

Disclosures:

S. S. Huang, None

L. Miller, None

A. Gombosev, None

L. M. Portillo, None

K. Lolans-Mazza, None

R. D. Singh, None

D. Kim, None

E. Cui, None

S. J. Eells, None

J. A. Mckinnell, None

M. K. Hayden, Sage Inc: Research Affiliate, Contributed product for federally funded research study

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