Is it possible something as simple as a special cleanser could save a patient from getting a health care-associated infection?
The federal Centers for Disease Control and Prevention decided to test the theory. It examined chlorhexidine (CHG), an antimicrobial cleansing agent used primarily to bathe patients hospitalized in the intensive care unit, to see if it could prevent health care–associated infections (HAIs), particularly antibiotic-resistant staph infections, known as MRSAs, or “superbugs.”
Reducing superbugs is critical because they can cause severe disease, are resistant to treatment and are increasingly common in health care settings, particularly among intensive care unit (ICU) patients, the CDC stated on its Prevention Epicenters Program website.
According to the CDC, antibiotic resistance is one of the country’s biggest public health challenges. Each year, at least 2 million people in the U.S. get an antibiotic-resistant infection, and at least 23,000 people die.
The nearly $8 million study was funded and conducted by both the CDC and the Agency for Healthcare Research and Quality (AHRQ) — two agencies of the U.S. Department of Health and Human Services. The 18-month-long study was published in the New England Journal of Medicine.
“There is clear evidence in the medical literature that for hospitals with high rates of infection, CHG can reduce the risk (of HAIs),” said Kathy Mathews, RN, and manager of the patient experience/infection-prevention program at Sonoma Valley Hospital, a community hospital in the city of Sonoma.
“SVH has very few hospital-acquired infections, so the use of CHG is limited to wiping patients with CHG-impregnated wipes who are going to receive total joint-replacement surgery,” she said, adding these patients are wiped the night before, day of and two days after surgery to reduce the risk of surgical-site infections.
Multiple studies have shown value to cleaning the skin of patients with CHG, said Jeffrey Silvers, medical director of infection control, Sutter Health Bay Area. He said the best data is on patients who have a central venous catheter — one that is left inside the body either temporarily or permanently.
That is protocol at Santa Rosa Memorial Hospital and Petaluma Valley Hospital, according to Jennifer Cole, M.S.N., R.N., CIC, infection prevention manager for both St. Joseph Health Northern California hospitals.
“Our patients receive a daily chlorhexidine bath if they have a central venous catheter,” said Cole, adding the practice is in addition to using chlorhexidine wipes to bathe patients before going to surgery.
“Preoperative bathing with CHG is frequently performed, although it still remains somewhat controversial as to whether an antiseptic agent works better than soap and water to prevent surgical-site infections,” Silvers said.
He pointed to CDC guidance that advises for patients to shower or bathe with soap (antimicrobial or non-antimicrobial) or an antiseptic agent on at least the night before the operative day.
“Some other products that are more physiologic and less disruptive to the natural skin are being studied and may ultimately replace CHG," Silvers said. "(There is) no timeline, but companies are doing research.”
The HAI-prevention research project was comprised of 74 ICUs in 43 hospitals, and involved nearly 75,000 patients across 16 states, including California, according to the CDC.
The researchers found that treating all ICU patients as if they carry MRSA on their bodies can reduce bloodstream infections from MRSA and other germs by more than 40 percent, according to the study’s findings.