The Effectiveness of Chlorhexidine bath in the prevention of Methicillin Resistant Staphylococcus Aureus (MRSA) in the Adult inpatient wards. A systematic review.

Abstract

Review question/objective Objectives: Primary 1) To evaluate the effectiveness of chlorhexidine bath in eradicating MRSA carriage. 2) To evaluate the efficacy of chlorhexidine bath on MRSA incidence rate in the adult inpatient wards. 3) To evaluate the effectiveness of chlorhexidine bathing with or without topical decolonization therapy in reducing risk of MRSA infection among MRSA colonized inpatients. Secondary: 1) To evaluate the development of MRSA infection and tolerance to chlorhexidine bath with or without topical decolonization therapy. 2) To assess the effectiveness of chlorhexidine bath on the rates of Blood Stream Infections (BSI). Review Questions: 1) Can chlorhexidine bath reduce the acquisition rate of MRSA during their hospitalisation? 2) Is the use of chlorhexidine more effective in preventing incidence of MRSA than soap and water? 3) Is the combination of chlorhexidine bath and decolonization therapy more effective in the eradicating MRSA than chlorhexidine bath alone? 4) Can Chlorhexidine bath alone decrease blood stream infection? Inclusion criteria Types of participants - Adults over age of 18 - Both Female and Male - Admitted to inpatient adult wards - Admitted with MRSA surveillance screening swab cultures performed on the following screening sites: nasal nares, axilla and groin on admission prior to treatment. (Patient who have MRSA surveillance cultures done on admission and results shows to be infected or colonised) Types of intervention(s)/phenomena of interest The use of chlorhexidine shower/bath/wipes/wash with or without combination of other pharmacological therapies such as antibiotics, topical decolonisation therapy for MRSA. The various administration methods, duration and frequency will be included in the review. Types of Comparator The comparator group includes no chlorhexidine shower (usual care with soap and water), with or without antibiotics or topical decolonisation therapy. Types of outcomes The outcomes of interest include: 1) Development of MRSA infection: Objective or subjective indicators of MRSA infection: Culture results or clinical evidence of infections 2) Eradication of MRSA carriage using chlorhexidine shower/bath/wipes/wash Outcome: 1) The duration and the frequency of the use of daily chlorhexidine shower to eradicate skin and nasal carriage of MRSA & preventing colonisation. 2) Comparative Benefits of combination therapy with chlorhexidine shower with decolonisation therapy vs. chlorhexidine shower only. 3) Tolerance to chlorhexidine shower with or without decolonisation therapy. 4) Blood stream infection (with or without MRSA)