220. Impact of Daily Chlorhexidine Bath and Hand Hygiene on the Nosocomial Infection Rate in Critically Ill Patients
Session: Poster Abstract Session: Criticare, HAIs: Pneumonia and Chlorhexidine
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background: Previous studies suggest that daily bathing of patients with chlorhexidine and enhancing hand hygiene (HH) may prevent hospital-acquired infections. We conducted a trial to assess the impact of a combined intervention using clorhexidine impregnated wipes and enhancing hand hygiene compliance on the nosocomial infection rate.

Methods: Comparative and interventional study: 2 periods lasting 6 months each, one prior to intervention (January 2012 to June 2012) and one during intervention (July 2012 to December 2012). The study took place in a 20 bed adult intensive care unit (medical and surgical). The intervention consisted of daily corporal bathing by 2% clorhexidine wipes and clorhexidine shampoo beginning on admission until discharge from the unit. During the complete study, all healthcare personnel were instructed on the proper technique for HH and were encouraged to comply. HH compliance was assessed daily by the epidemiology unit personnel. Infection rates per discharge and per hospitalized days were compared, as well as specific infection rates and HH compliance.

Results: There were 687 patients included (341 patients prior to intervention and 346 during intervention) and 1014 observations of HH compliance were realized (503 prior and 511 during intervention). Infection rate per 100 discharges was 68.4 prior vs. 36.2 during intervention (p=0.002). The global infection rate per 1000 hospitalized days was 88.7 prior vs. 56.8 during intervention (p=0.01). Stratified by infection type, the rate of ventilator-associated pneumonia (VAP) per 1000 ventilator-days was 24.3 prior vs. 13.4 during intervention (p=0.02), the rate of catheter-associated urinary tract infection per 1000 catheter-days (CA-UTI) was 28.8 prior vs. 14.8 during intervention (p=0.002) and the rate of central line associated blood stream infection (CLABSI) per 1000 central venous catheter-days was 16.1 prior and 13.7 during intervention (p=0.48). Hand hygiene compliance on average was 59.8% prior vs. 71.3% during intervention (p=0.0001).

Conclusion: Daily chlorhexidine bath and enhanced hand hygiene compliance in critically ill patients accomplished a reduction in the global rate of infections. The major impact was observed with VAP and CA-UTI. There was no significant difference in the rate of CLABSI.

 

Michel F Martinez-Resendez, MD1, Adrian Camacho-Ortiz Sr., MD2, Juan Rodriguez-Lopez, RN3, Alexis S Herrera-Guerra, MD4, Soraya S Mendoza-Olazaran5, Edelmiro Perez-Rodriguez, MD6, Roberto Mercado-Longoria, MD6 and Elvira Garza-Gonzalez, Ph.D.5, (1)Infectious Diseases, University Hospital “Dr. José Eleuterio González” Universidad Autónoma de Nuevo León., Monterrey, Mexico, (2)Infectious Disease, University Hospital "Dr. Jose Eleuterio Gonzalez" Universidad Autonoma de Nuevo Leon, Monterrey, Mexico, (3)Hospital Epidemiology, University Hospital, Monterrey, Mexico, (4)Internal Medicine, University Hospital "Dr. Jose Eleuterio Gonzalez" Universidad Autonoma de Nuevo Leon, Monterrey, Mexico, (5)University Hospital, Monterrey, Mexico, (6)University Hospital "Dr. Jose Eleuterio Gonzalez" Universidad Autonoma de Nuevo Leon, Monterrey, Mexico

Disclosures:

M. F. Martinez-Resendez, None

A. Camacho-Ortiz Sr., None

J. Rodriguez-Lopez, None

A. S. Herrera-Guerra, None

S. S. Mendoza-Olazaran, None

E. Perez-Rodriguez, None

R. Mercado-Longoria, None

E. Garza-Gonzalez, None

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