Efficacy of an antiseptic body cleanser for reducing skin contamination with vancomycin-resistant enterococci.

摘要

Gastrointestinal colonization with vancomycin-resistant enterococci (VRE) frequently is associated with skin contamination, which may increase the risk of infection, transmission between patients, or environmental contamination. A 2% chlorhexidene gluconate (CHG) body cleanser was compared to soap and water baths for control of VRE in a medical intensive care unit (MICU).; From October 14, 2002 to February 14, 2003 daily soap and water baths were administered to all patients in an MICU. From February 22, 2003 through July 29, 2003 patients were bathed with a no-rinse, CHG washcloth system. Rectal cultures were used to identify VRE colonization. Among colonized patients, four daily skin (inguinal and antecubital) and environmental (sheet, table, and bedrail) cultures were obtained: pre-bath and 2, 4, and 6 hours post-bath. Hands of healthcare workers (HCWs) were cultured after patient care. All cultures were quantitative. The frequency and degree of VRE contamination on patients' skin, on environmental surfaces, and on the hands of HCWs were compared during the two bath phases.; Thirty-six colonized patients were evaluated in each of the two bath phases. At the inguinal site, there was significantly greater contamination during the soap and water phase compared to CHG cleansing at all culture times (median CFU [log₁₀] 1.4 vs. 0; p 0.001). At the antecubital site, the frequency of VRE contamination was significantly higher during soap and water baths compared to CHG cleansing (47% vs. 11%; p 0.001). Among 98 VRE-contaminated HCW hands, the degree of contamination was higher during the soap and water compared to the CHG phase (median CFU [log₁₀] 1.6 vs. 0.5; p 0.001). The degree of VRE contamination on all environmental sites combined was higher during soap and water compared to the CHG phase (median CFU [log₁₀] 0.1 vs. 0; p = 0.004).; Compared to soap and water baths, use of a 2% CHG cleansing system resulted in decreased patient skin, environmental, and healthcare worker hand contamination by VRE. Bathing ICU patients with CHG-impregnated cloths may be a useful adjunct to other infection control measures to reduce VRE transmission.