EFEKTIFITAS MANDI CHLORHEXIDINE GLUCONATE TERHADAP PENURUNAN ANGKA KEJADIAN HAIs: LITERATURE REVIEW

INTISARI : Latar Belakang: Insiden Health-care Associated Infections (HAIs) atau infeksi yang berhubungan dengan pelayanan kesehatan di dunia semakin meningkat sehingga menyebabkan morbiditas, mortalitas, dan biaya tinggi bagi rumah sakit. Klorheksidin glukonat sebagai antiseptik dengan aktivitas antimikroba spektrum luas telah ditunjukkan dalam beberapa penelitian sebagaiABSTRAKLatar belakang: Penyakit infeksi di fasilitas kesehatan atau disebut juga Healthcare Associated Infections (HAIs) menjadi masalah besar yang masuk ke rumah sakit karena dapat meningkatkan angka morbiditas (kesakitan), angka mortalitas (kematian) dan menambah biaya perawatan yang besar bagi rumah sakit. Chlorhexidine gluconate sebagai antiseptik dengan aktivitas antimikroba spektrum luas merupakan komponen penting dalam pencegahan infeksi. Rutinitas mandi harian di perawatan kritis dan intensif dan mandi sebelum operasi dengan sabun Chlorhexidine gluconatetelah menurunkan infeksi aliran darah, infeksi daerah operasi dan akuisi organisme patogen berbahaya dan resisten yang terdapat di rumah sakit. Namun karena belum konsistennya hasil penelitian terkait hal ini, akibatnya mandi Chlorhexidine belum dilakukan secara universal sebagai prosedur tetap dan masih menyisakan sampai sekarang. Kajian literatur ini bertujuan untuk menilai efektifitas mandi Chlorhexidine gluconate terhadap penurunan kejadian infeksi yang berkaitan dengan kesehatan dan mikroorganisme penyebabnya.Metode: Penulis melakukan pencarian literatur dengan mengumpulkan beberapa artikel terindeks yang berhubungan dengan topik yang diangkat menggunakan database seperti Clinical key, Elsevier, ProQuest , dan ScienceDirect dengan kata kunci chlorhexidine gluconate, chlorhexidine bathing, health care related infeksi .Hasil: Dari 3871 artikel umum, dilakukan penyaringan menjadi 269 artikel yang terkait, dikumpulkan sebanyak 16 artikel yang sesuai dengan topik dan 8 artikel yang sesuai kriteria sebagai bahan kajian literatur.Kesimpulan: Penulis menyimpulkan bahwa mandi dengan Chlorhexidine gluconate secara rutin penerapan “ bundles ” pencegahan dapat menurunkan prevalensi mikroorganisme berbahaya termasuk kuman patogen yang resisten terhadap antimikroba, namun efektifitas biaya, integritas kulit dan resistensi tetap harus. Kata kunci: chlorhexidine gluconate, mandi chlorhexidine, infeksi terkait perawatan kesehatan ABSTRAKLatar Belakang: Infectious diseases in health facilities also known as Healthcare Associated Infections (HAIs) are major problem facing hospitals because they can increase morbidity rates (pain), mortality rates (deaths) and increase the cost of care for hospitals. Chlorhexidine gluconate as an antiseptic with broad spectrum antimicrobial activity is an important component in infection prevention. Daily bathing routine in critical or intensive care and pre-surgery showers with Chlorhexidine soap have reduced bloodstream infections, surgical area infections and the acquisition of harmful and resistant pathogenic organisms found in hospitals. However, due to the inconsistency of research results related to this matter, as a result chlorhexidine bathing has not been done universally as a permanent procedure and still leaves debate until now. This literature review aims to assess the effectiveness of chlorhexidine gluconate baths in reducing the incidence of infections related to health services and their causative microorganisms. Metode: Penulis melakukan pencarian dengan mengumpulkan beberapa artikel terindeks yang berhubungan dengan topik yang diangkat dari beberapa database seperti Clinical keys, Elsevier, ProQuest dan ScienceDirect dengan kata kunci chlorhexidine gluconate, chlorhexidine bathing, perawatan kesehatan terkait infeksi .Hasil: Dari 3871 artikel umum yang disaring menjadi 269 artikel terkait, didapatkan sebanyak 16 artikel yang sesuai dengan topik dan 8 artikel yang memenuhi kriteria sebagai bahan studi literatur.Kesimpulan: Penulis menyimpulkan bahwa mandi dengan klorheksidin glukonat secara rutin dengan aplikasi “bundel” pencegahan infeksi dapat menurunkan prevalensi mikroorganisme berbahaya termasuk patogen resisten antimikroba, namun pertimbangan efektivitas biaya, integritas kulit, dan resistensi tetap harus diperhatikan. Kata kunci: klorheksidin glukonat, mandi klorheksidin, infeksi terkait perawatan kesehatankomponen tant dalam pencegahan infeksi di unit perawatan pasien. Salah satunya dengan rutinitas mandi sehari-hari di ruang perawatan kritis / intensif dan mandi sebelum operasi dengan sabun klorheksidin telah mengurangi infeksi aliran darah, infeksi area operasi dan didapatnya organisme patogen berbahaya dan resisten yang terdapat di rumah sakit. Namun karena ketidakkonsistenan hasil penelitian terkait hal tersebut, akibatnya mandi klorheksidin belum dilakukan secara universal sebagai prosedur permanen dan masih menyisakan perdebatan hingga saat ini. Tinjauan pustaka ini bertujuan untuk menilai keefektifan mandi klorheksidin glukonat dalam mengurangi kejadian infeksi yang berkaitan dengan layanan kesehatan dan mikroorganisme penyebabnya.Metode: Metode yang digunakan adalah penelusuran literatur baik nasional maupun internasional yang dilakukan dengan menggunakan database Clinical keys, Elsevier, ProQuest, dan lain-lain.Hasil: Dari hasil pencarian diperoleh sebanyak 22 artikel terkait yang dijadikan studi literatur.Kesimpulan: Penulis menyimpulkan bahwa mandi dengan klorheksidin glukonat secara rutin dengan aplikasi “bundel” pencegahan infeksi dapat menurunkan prevalensi mikroorganisme berbahaya termasuk patogen resisten antimikroba, namun pertimbangan efektivitas biaya, integritas kulit, dan resistensi tetap harus diperhatikan.

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Assessing the Potential for Unintended Microbial Consequences of Routine Chlorhexidine Bathing for Prevention of Healthcare-associated Infections

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1103 ◽

2020 ◽

Author(s):

Ahmed Babiker ◽

Joseph D Lutgring ◽

Scott Fridkin ◽

Mary K Hayden

Keyword(s):

Safety Profile ◽

Wide Spectrum ◽

Multidrug Resistant ◽

Chlorhexidine Gluconate ◽

Healthcare Associated Infections ◽

Chlorhexidine Bathing ◽

Excellent Safety Profile ◽

Healthcare Associated

Abstract Chlorhexidine gluconate (CHG) is an antiseptic that is widely used in healthcare due to its excellent safety profile and wide spectrum of activity. Daily bathing with CHG has proven to be effective in the prevention of healthcare-associated infections and multidrug-resistant pathogen decolonization. Despite the proven benefits of CHG use, there remain concerns and unanswered questions about the potential for unintended microbial consequences of routine CHG bathing. This review aims to explore some of these questions.

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HCAIs: A Statutory Code of Practice in England and Wales

Journal of Perioperative Practice ◽

10.1177/175045890701700604 ◽

2007 ◽

Vol 17 (6) ◽

pp. 266-271 ◽

Cited By ~ 4

Author(s):

Diane Gilmour

Keyword(s):

Health Care ◽

Staphylococcus Aureus ◽

Clostridium Difficile ◽

Healthcare Associated Infections ◽

Infection Rates ◽

Code Of Practice ◽

Health Care Associated Infections ◽

The Media ◽

Mrsa Infection ◽

Healthcare Associated

Healthcare-associated infections (HCAIs) such as Meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C. dif) are never far from the media headlines. In January 2006 a leaked memo identified the government's concerns that its target of halving MRSA infection rates by April 2008 may not be met (Boseley 2007). During 2004–5, 30 people died following two outbreaks of C. dif at Stoke Mandeville (Boseley 2007). In this article the author will focus on and discuss in detail key components of the new Code of Practice on Health Care Associated Infections (DH 2006a) to show how legislation has provided the framework to ensure that not only do NHS bodies have a duty to comply with this Act but so do we as practitioners.

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Healthcare-Associated Infections: Not Only a Clinical Burden, But a Forensic Point of View

Current Pharmaceutical Biotechnology ◽

10.2174/1389201020666190618122649 ◽

2019 ◽

Vol 20 (8) ◽

pp. 658-664 ◽

Cited By ~ 2

Author(s):

Marco Di Paolo ◽

Luigi Papi ◽

Paolo Malacarne ◽

Federica Gori ◽

Emanuela Turillazzi

Keyword(s):

Health Care ◽

Clinical Medicine ◽

Methodological Approach ◽

Care Facility ◽

Public Health Problem ◽

Control Measures ◽

Major Public Health Problem ◽

Healthcare Associated Infections ◽

Open Communication ◽

Healthcare Associated

Background: Healthcare-associated infections (HCAIs) occur when patients receiving treatment in a health care setting develop an infection. They represent a major public health problem, requiring the integration of clinical medicine, pathology, epidemiology, laboratory sciences, and, finally, forensic medicine. Methods: The determination of cause of death is fundamental not only in the cases of presumed malpractice to ascertain the causal link with any negligent behavior both of health facilities and of individual professionals, but also for epidemiological purposes since it may help to know the global burden of HCAIs, that remains undetermined because of the difficulty of gathering reliable diagnostic data. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insult, is mandatory in HCAIs related deaths. Results: Important tasks for forensic specialists in hospitals and health services centers are the promotion of transparency and open communication by health-care workers on the risk of HCAIs, thus facilitating patients’ engagement and the implementation of educational interventions for professionals aimed to improve their knowledge and adherence to prevention and control measures. Conclusion: HCAIs are a major problem for patient safety in every health-care facility and system around the world and their control and prevention represent a challenging priority for healthcare institution and workers committed to making healthcare safer. Clinicians are at the forefront in the war against HCAIs, however, also forensic pathologists have a remarkable role.

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Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.956 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s343-s344

Author(s):

Margaret A. Dudeck ◽

Katherine Allen-Bridson ◽

Jonathan R. Edwards

Keyword(s):

Acute Care ◽

National Level ◽

Bloodstream Infections ◽

Acute Care Hospitals ◽

Central Line ◽

Patient Specific ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Repeat Infection ◽

Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

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Burden of healthcare-associated infections among hospitalized children within community hospitals participating in an infection control network

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.67 ◽

2021 ◽

pp. 1-3

Author(s):

Ibukunoluwa C. Akinboyo ◽

Rebecca R. Young ◽

Michael J. Smith ◽

Sarah S. Lewis ◽

Becky A. Smith ◽

...

Keyword(s):

Infection Control ◽

Bloodstream Infections ◽

Central Line ◽

Control Network ◽

Hospitalized Children ◽

Healthcare Associated Infections ◽

Community Hospitals ◽

Prospective Surveillance ◽

Healthcare Associated ◽

Pediatric Healthcare

Abstract We describe the frequency of pediatric healthcare-associated infections (HAIs) identified through prospective surveillance in community hospitals participating in an infection control network. Over a 6-year period, 84 HAIs were identified. Of these 51 (61%) were pediatric central-line–associated bloodstream infections, and they often occurred in children <1 year of age.

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Healthcare-associated Infections in Pediatric Cardiovascular Surgery Intensive Care Unit between 2016-2020

Kosuyolu Heart Journal ◽

10.51645/khj.2021.m125 ◽

2021 ◽

Author(s):

Mehmet Emirhan Işık ◽

Ergin Arslanoğlu ◽

Ömer Faruk Şavluk ◽

Hakan Ceyran

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cardiovascular Surgery ◽

Heart Diseases ◽

Bloodstream Infections ◽

Healthcare Associated Infections ◽

Developmental Problems ◽

Pediatric Cardiovascular Surgery ◽

Tract Infections ◽

Healthcare Associated

Objectives: Healthcare-associated infections are the most common problem in intensive care unit worldwide. Children with congenital heart diseases have many complications such as developmental problems, respiratory tract infections, endocarditis,pneumonia and after long-term hospital and intensive care stays and surgeries patients become vulnerable to healthcare-associated infections. Patients and Methods: The study presents the frequency of infection, microorganisms in patients hospitalized at SBÜ Koşuyolu High Spesialization Research and Training Hospital pediatric cardiovascular surgery intensive care unit between 2016-2020. Results: One hundred-eight HAI episodes were seen in 83 of 1920 patients hospitalized in pediatric cardiovascular surgery intensive care unit between 2016-2020.HAI rates varied between 4.8% and 7.77%. In the 5-year period,a total of 118 different microorganisms were detected.Among all microorganisms, Candida species (n: 43, 36.4%) ranked first. central line-associated bloodstream infections (CLABSI) 53 (49%), ventilator-associated pneumonia (VAP)40 (37%), surgical site infection (SSI) 8 (6.5%), catheter -associated urinary tract infection (CAUTI) 7 (6%) Conclusion: Healthcare-associated infections are require special attention in pediatric cardiovascular intensive care units. In order to prevent, innovations such as bundle applications should be implemented as well as personnel training.

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Chlorhexidine Gluconate Bathing Program to Reduce Health Care–Associated Infections in Both Critically Ill and Non–Critically Ill Patients

Critical Care Nurse ◽

10.4037/ccn2021340 ◽

2021 ◽

Vol 41 (5) ◽

pp. e1-e8

Author(s):

Leigh Chapman ◽

Lisa Hargett ◽

Theresa Anderson ◽

Jacqueline Galluzzo ◽

Paul Zimand

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Chlorhexidine Gluconate ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Telemetry Unit ◽

Health Care Associated Infections ◽

The Impact

Background Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care–associated infections, which affect patients’ lives and health care systems in various ways. Objective To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care–associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. Methods A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care–associated infections. Results Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care–associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care–associated infections. Conclusion A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care–associated infections in intensive care unit and non–intensive care unit hospital settings.

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Everybody Nose: Molecular and Clinical Characteristics of Nasal Colonization During Active Methicillin-Resistant Staphylococcus Aureus Bloodstream Infection

10.21203/rs.3.rs-1112075/v1 ◽

2021 ◽

Author(s):

Erika Reategui Schwarz ◽

Adriana van de Guchte ◽

Amy C. Dupper ◽

Ana Berbel Caban ◽

Devika Nadkarni ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Bloodstream Infection ◽

Bloodstream Infections ◽

Invasive Disease ◽

Nasal Colonization ◽

Healthcare Associated Infections ◽

Staphylococcal Protein A ◽

Record System ◽

Methicillin Resistant ◽

Healthcare Associated

Abstract Background. Healthcare-associated infections pose a potentially fatal threat to patients worldwide and Staphylococcus aureus is one of the most common causes of healthcare-associated infections. S. aureus is a common commensal pathogen and a frequent cause of bacteremia, with studies demonstrating that nasal and blood isolates from single patients match more than 80% of the time. Here we report on a contemporary collection of colonizing isolates from those with methicillin-resistant S. aureus (MRSA) bloodstream infections to evaluate the diversity within hosts, and detail the clinical features associated with concomitant nasal colonization.Methods. Swabs of the bilateral anterior nares were obtained from patients diagnosed with MRSA bacteremia. A single colony culture from the blood and an average of 6 colonies from the nares were evaluated for MRSA growth. For the nares cultures, we typed multiple isolates for staphylococcal protein A (spa) and derived the clonal complexes. Demographic and clinical data were obtained retrospectively from the electronic medical record system and analysed using univariate and multivariable regression models.Results. Over an 11-month period, 68 patients were diagnosed with MRSA bloodstream infection, 53 were swabbed, and 37 (70%) were colonized with MRSA in the anterior nares. We performed molecular typing on 210 nasal colonies. Spa types and clonal complexes found in the blood were also detected in the nares in 95% of the cases. We also found that 11% of patients carried more than one clone of MRSA in the nares. Male sex and history of prior hospitalization within the past 90 days increased odds for MRSA colonization. Conclusion. The molecular epidemiological landscape of colonization in the setting of invasive disease is diverse and defining the interplay between colonization and invasive disease is critical to combating invasive MRSA disease.

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Delayed Tuberculosis Diagnosis in a Low Incidence Country and its Effect on Cost of Care

10.21203/rs.3.rs-1138557/v1 ◽

2021 ◽

Author(s):

James O'Connell ◽

Niamh Reidy ◽

Cora McNally ◽

Debbi Stanistreet ◽

Eoghan de Barra ◽

...

Keyword(s):

Health Care ◽

Health Care Provider ◽

Care Provider ◽

Delayed Diagnosis ◽

Signs And Symptoms ◽

Cost Of Care ◽

Global Priority ◽

Low Incidence ◽

The Cost ◽

Health Care Records

Abstract Background Tuberculosis elimination (TB) is a global priority that requires high-quality timely care to be achieved. In low TB incidence countries such as Ireland, delayed diagnosis is common. Despite cost being central to policy making, it is not known if delayed care affects care cost among TB patients in a low-incidence setting. Methods Health care records of patients with signs and symptoms of TB evaluated by a tertiary service in Ireland between July 1st 2018 and December 31st 2019 were reviewed to measure and determine predictors of patient-related delays, health care-provider related delay and the cost of TB care. Benchmarks against which the outcomes were compared were derived from the literature. Results Thirty-seven patients were diagnosed with TB and 51% (19/37) had pulmonary TB (PTB). The median patient-related delay was 60 days among those with PTB, greater than the benchmark derived from the literature (38 days). The median health care provider-related delay among patients with PTB was 16 days and, although similar to the benchmark (median 22 days, minimum 11 days, maximum 36 days) could be improved. The health care-provider related delay among patients with EPTB was 66 days, greater than the benchmark (42 days). The cost of care was €8298, and while similar to that reported in the literature (median €9,319, minimum €6,486, maximum €14,750) could be improved. Patient-related delay among those with PTB predicted care costs. Conclusion Patient-related and health care-related delays in TB diagnosis in Ireland must be reduced. Initiatives to do so should be resourced.

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Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.507 ◽

2022 ◽

pp. 1-6

Author(s):

Robert J. Clifford ◽

Donna Newhart ◽

Maryrose R. Laguio-Vila ◽

Jennifer L. Gutowski ◽

Melissa Z. Bronstein ◽

...

Keyword(s):

Control Charts ◽

Bloodstream Infections ◽

Central Line ◽

Healthcare Associated Infections ◽

Full Time ◽

Staffing Levels ◽

Clostridioides Difficile ◽

Carbapenem Resistant ◽

Healthcare Associated ◽

Carbapenem Resistant Enterobacteriaceae

Abstract Objective: To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs). Design and setting: An ambidirectional observation in a 528-bed teaching hospital. Patients: All inpatients from July 1, 2012, to February 1, 2021. Methods: Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2–3 FTE), below recommended IP levels (4–6 FTE), and at recommended IP levels (7–8 FTE). Results: The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7–8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line–associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist. Conclusions: Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders.

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