Chlorhexidine Gluconate Bathing Outside the Intensive Care Unit

Abstract

Chlorhexidine gluconate is a biguanide antiseptic with both bacteriostatic and bactericidal activities against gram-positive and gram-negative bacteria (both aerobes and anaerobes), fungi, and some enveloped viruses, but is not sporicidal (Milstone AM, Passaretti CL, Perl TM, Clin Infect Dis 46(2):274–281, 2008). One of the benefits is that it maintains residual activity for hours after it is applied (Whitman TJ, Herlihy RK, Schlett CD et al, Infect Control Hosp Epidemiol 31(12):1207–1215, 2010; Edmiston CE Jr, Krepel CJ, Seabrook GR, Lewis BD, Brown KR, Towne JB, J Am Coll Surg 207(2):233–239, 2008). It has been employed with increased frequency in healthcare settings for infection control and prevention. Over the last decade, several studies have documented the success of daily chlorhexidine (CHG) bathing as a means of source control in intensive care unit (ICU) settings. Daily CHG bathing in the medical ICU has been associated with a reduction in patient colonization with potential pathogens as well as a decrease in contamination of healthcare worker hands, thus likely reducing transmission of these potential pathogens to other patients (i.e., “source control”) (Vernon MO, Hayden MK, Trick WE et al, Arch Intern Med 166(3):306–312, 2006). In addition, daily CHG bathing in various types of ICUs (medical, surgical, trauma) has led to reductions in healthcare-associated infections, including those due to multidrug-resistant organisms such as vancomycin-resistant Enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) (Climo MW, Yokoe DS, Warren DK et al, N Engl J Med 368(6):533–542, 2013). As a result of the several studies demonstrating the effectiveness of CHG bathing in ICUs, several hospitals across the United States now use CHG for patient bathing in the ICU. This has prompted extension of the use of CHG from the ICU to hospital wards and ambulatory, institutional, and community populations. There may be a significant value of CHG bathing outside the ICU for both infection control and infection prevention. However, it is also essential to recognize the potential challenges of CHG bathing in more mobile and healthy patient populations.