title: Reduction in hospital-associated methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus with daily chlorhexidine gluconate bathing for medical inpatients.
abstract: BACKGROUND
  Daily bathing with chlorhexidine gluconate (CHG) is increasingly used in intensive care units to prevent hospital-associated infections, but limited evidence exists for noncritical care settings.
  
  
  METHODS
  A prospective crossover study was conducted on 4 medical inpatient units in an urban, academic Canadian hospital from May 1, 2014-August 10, 2015. Intervention units used CHG over a 7-month period, including a 1-month wash-in phase, while control units used nonmedicated soap and water bathing. Rates of hospital-associated methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization or infection were the primary end point. Hospital-associated S. aureus were investigated for CHG resistance with a qacA/B and smr polymerase chain reaction (PCR) and agar dilution.
  
  
  RESULTS
  Compliance with daily CHG bathing was 58%. Hospital-associated MRSA and VRE was decreased by 55% (5.1 vs 11.4 cases per 10,000 inpatient days, P = .04) and 36% (23.2 vs 36.0 cases per 10,000 inpatient days, P = .03), respectively, compared with control cohorts. There was no significant difference in rates of hospital-associated Clostridium difficile. Chlorhexidine resistance testing identified 1 isolate with an elevated minimum inhibitory concentration (8 µg/mL), but it was PCR negative.
  
  
  CONCLUSIONS
  This prospective pragmatic study to assess daily bathing for CHG on inpatient medical units was effective in reducing hospital-associated MRSA and VRE. A critical component of CHG bathing on medical units is sustained and appropriate application, which can be a challenge to accurately assess and needs to be considered before systematic implementation.
authors.affiliation: Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada; Division of Medical Microbiology, Providence Health Care, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada. Electronic address: clowe@providencehealth.bc.ca.
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Lowe
authors.affiliation: Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada.
authors.forename: Elisa
authors.initials: E
authors.lastname: Lloyd-Smith
authors.affiliation: Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada.
authors.forename: Baljinder
authors.initials: B
authors.lastname: Sidhu
authors.affiliation: Division of Medical Microbiology, Providence Health Care, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Gordon
authors.initials: G
authors.lastname: Ritchie
authors.affiliation: Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada.
authors.forename: Azra
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Division of Medical Microbiology, Providence Health Care, Vancouver, BC, Canada.
authors.forename: Willson
authors.initials: W
authors.lastname: Jang
authors.affiliation: Division of Medical Microbiology, Providence Health Care, Vancouver, BC, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Wong
authors.affiliation: Division of Medical Microbiology, Providence Health Care, Vancouver, BC, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bilawka
authors.affiliation: Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Richards
authors.affiliation: Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kind
authors.affiliation: Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Puddicombe
authors.affiliation: Division of Medical Microbiology, Providence Health Care, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Champagne
authors.affiliation: Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada; Division of Medical Microbiology, Providence Health Care, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Infectious Diseases, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Victor
authors.initials: V
authors.lastname: Leung
authors.affiliation: Infection Prevention and Control, Providence Health Care, Vancouver, BC, Canada; Division of Medical Microbiology, Providence Health Care, Vancouver, BC, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Marc G
authors.initials: MG
authors.lastname: Romney
mesh_terms: D000046:Academic Medical Centers; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001494:Baths / Q000379:methods*; D002170:Canada; D002353:Carrier State / Q000517:prevention & control; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003428:Cross Infection / Q000517:prevention & control*; D018592:Cross-Over Studies; D004203:Disinfection / Q000379:methods*; D006786:Hospitals, Urban; D006801:Humans; D007297:Inpatients; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011446:Prospective Studies; D016896:Treatment Outcome; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification*
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: CHG; Chlorhexidine gluconate; Horizontal; Nosocomial infection