Chlorhexidine For Skin Antisepsis Research Articles

Chlorhexidine for skin antisepsis: making the case to keep peripheral venous catheters CLEAN

Chlorhexidine for skin antisepsis: making the case to keep peripheral venous catheters CLEAN

Yoğun bakım hastalarında kateter ilişkili kan dolaşımı enfeksiyonlarının önlenmesinde kanıta dayalı önerilerin etkinliğinin incelenmesi

Objective: Although central venous catheter (CVC) is a vital initiative, it causes serious complication among intensive care unit (ICU) patients. The most important of these is catheter related bloodstream infection (CRBSI). CRBSI increases morbidity, mortality and costs. The aim of this review is to examine the results of implemented interventions as the bundle of evidence-based guidelines recommendations for prevention and/ or reduction of CRBSI among adult hospitalized patients in the ICU. Material and Methods: In order to reach the relevant study, BMJ Online Journals, Cochrane, EBSCOhost, Elsevier Science Direct, Medline, OVID-Lippincott Williams & Wilkins database were scanned. The full text can be accessed, published between 2000-2014, English studies were included in the review. All studies that have implemented the preventive bundle approach in adult patients who had non-tunneled central line in the ICU and have reported the CRBSI rate or number of event were included in the review. A standard assessment has not been made with regard to design or methodological quality of reached studies. Results: Twenty one studies were included in the review. The initiatives implemented in the study were presented in the following categories: education, prefer to subclavian site, evaluation of CVC requirements, hand hygiene, maximal sterile barrier precautions, chlorhexidine for skin antisepsis, checklist, empowering nurses to stop procedures, CVC insertion cart, adequate catheter care, replacement of administration sets, needleless intravascular catheter systems, evaluation of adherence to guidelines and other initiatives. Statistically significant reduction was found between the preintervention and postintervention period for CRBSI rate in 18 studies except only one study. In only one study, CRBSI rates between preintervention and postintervention period were equal. Conclusions: CRBSI rate was shown to decrease between 26% at first year of intervention and 95% at second year after intervention with implemented as the bundle of recommended interventions in the guidelines. As a result, the bundle approach has been revealed to be effective and sustainable to reduce CRBSI in adult ICU patients.

Reduction in Staphylococcus aureus bacteraemia rates in patients receiving haemodialysis following alteration of skin antisepsis procedures

This study examined all cases of Staphylococcus aureus bacteraemia (SAB) in the haemodialysis cohort at the Royal Darwin Hospital, Australia over a seven-year period. Midway through this period, antisepsis for arteriovenous fistulae (AVF) and central venous catheters (CVC) changed from 0.5% chlorhexidine solution to 2% chlorhexidine solution. Rates of SAB episodes were calculated using registry data. Trends in SAB over time were analysed using an interrupted regression analysis. Following the change to 2% chlorhexidine, average SAB rates decreased by 68%, and it is estimated that 0.111 cases of SAB/patient-year were prevented. CVC-related SAB rates remained low throughout. These results support the use of 2% chlorhexidine in skin antisepsis for patients with AVF.

The Forgotten Role of Alcohol: A Systematic Review and Meta-Analysis of the Clinical Efficacy and Perceived Role of Chlorhexidine in Skin Antisepsis

BackgroundSkin antisepsis is a simple and effective measure to prevent infections. The efficacy of chlorhexidine is actively discussed in the literature on skin antisepsis. However, study outcomes due to chlorhexidine-alcohol combinations are often attributed to chlorhexidine alone. Thus, we sought to review the efficacy of chlorhexidine for skin antisepsis and the extent of a possible misinterpretation of evidence.MethodsWe performed a systematic literature review of clinical trials and systematic reviews investigating chlorhexidine compounds for blood culture collection, vascular catheter insertion and surgical skin preparation. We searched PubMed, CINAHL, the Cochrane Library, the Agency for Healthcare Research and Quality website, several clinical trials registries and a manufacturer website. We extracted data on study design, antiseptic composition, and the following outcomes: blood culture contamination, catheter colonisation, catheter-related bloodstream infection and surgical site infection. We conducted meta-analyses of the clinical efficacy of chlorhexidine compounds and reviewed the appropriateness of the authors′ attribution. ResultsIn all three application areas and for all outcomes, we found good evidence favouring chlorhexidine-alcohol over aqueous competitors, but not over competitors combined with alcohols. For blood cultures and surgery, we found no evidence supporting chlorhexidine alone. For catheters, we found evidence in support of chlorhexidine alone for preventing catheter colonisation, but not for preventing bloodstream infection. A range of 29 to 43% of articles attributed outcomes solely to chlorhexidine when the combination with alcohol was in fact used. Articles with ambiguous attribution were common (8–35%). Unsubstantiated recommendations for chlorhexidine alone instead of chlorhexidine-alcohol were identified in several practice recommendations and evidence-based guidelines.ConclusionsPerceived efficacy of chlorhexidine is often in fact based on evidence for the efficacy of the chlorhexidine-alcohol combination. The role of alcohol has frequently been overlooked in evidence assessments. This has broader implications for knowledge translation as well as potential implications for patient safety.

Corrections: “Prospective, Randomized, Double-Blind Trial of Local Anesthetic Infusion and Intravenous Narcotic Patient-Controlled Anesthesia Pump for Pain Management after Free TRAM Flap Breast Reconstruction: Are We on the Right Track?” and “Povidone-Iodine versus Chlorhexidine in Skin Antisepsis before Elective Plastic Surgery Procedures: A Randomized Controlled Trial. Is Statistical Correctness Always Pursued?”

Corrections: “Prospective, Randomized, Double-Blind Trial of Local Anesthetic Infusion and Intravenous Narcotic Patient-Controlled Anesthesia Pump for Pain Management after Free TRAM Flap Breast Reconstruction: Are We on the Right Track?” and “Povidone-Iodine versus Chlorhexidine in Skin Antisepsis before Elective Plastic Surgery Procedures: A Randomized Controlled Trial. Is Statistical Correctness Always Pursued?”

Povidone-Iodine versus Chlorhexidine in Skin Antisepsis before Elective Plastic Surgery Procedures: A Randomized Controlled Trial. Is Statistical Correctness Always Pursued?

Povidone-Iodine versus Chlorhexidine in Skin Antisepsis before Elective Plastic Surgery Procedures: A Randomized Controlled Trial. Is Statistical Correctness Always Pursued?

Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

Povidone Iodine versus Chlorhexidine in Skin Antisepsis before Elective Plastic Surgery Procedures: A Randomized Controlled Trial

Sir:One of the most important risk factors for surgical-site infection is the presence of bacteria in the wound at the time of surgery. Thus, the purpose of preoperative skin preparation is to reduce bacteria on the skin before making an incision.1,2The antiseptics most commonly used for antisepsis

Guidelines for the Prevention of Intravascular Catheter-related Infections: Recommendations Relevant to Interventional Radiology

THE revised version of the Centers for Disease Control Guidelines for the Prevention of Intravascular Catheterrelated Infections was published on August 9, 2002, in the Morbidity and Mortality Weekly Report Reports and Recommendations series (1). It replaces the previous guideline published in 1996. The goal of the new guidelines is to provide evidencebased recommendations for preventing catheter-related infections. The new document was prepared by a working group led by the Society of Critical Care Medicine, in collaboration with the Infectious Disease Society of America, Society for Healthcare Epidemiology of America, Surgical Infection Society, American College of Chest Physicians, American Thoracic Society, American Society of Critical Care Anesthesiologists, Association for Professionals in Infection Control and Epidemiology, Infusion Nurses Society, Oncology Nursing Society, Society of Interventional Radiology, American Academy of Pediatrics, and the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control. Major areas of emphasis in the new guidelines include (i) education and training of health-care providers who insert and maintain catheters, (ii) use of maximal sterile barrier precautions during central venous catheter (CVC) insertion, (iii) use of a 2% chlorhexidine preparation for skin antisepsis, (iv) avoidance of routine replacement of CVCs as a strategy to prevent infection, and (v) use of antisepticor antibiotic-impregnated short-term CVCs if the rate of infection is high despite adherence to other strategies (ie, education and training, maximum sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). The full guideline, available without charge at http:// www.cdc.gov/mmwr/PDF/RR/RR5110.pdf, is lengthy and includes numerous other recommendations (1). Portions of the new guideline are of particular interest to interventional radiologists, particularly those dealing with CVCs, peripherally inserted central catheters (PICCs), and hemodialysis catheters. Selected recommendations are presented verbatim here, along with selected supporting data, background information, and references.

Guidelines for the Prevention of Intravascular Catheter-related Infections: Recommendations Relevant to Interventional Radiology

THE revised version of the Centers for Disease Control Guidelines for the Prevention of Intravascular Catheterrelated Infections was published on August 9, 2002, in the Morbidity and Mortality Weekly Report Reports and Recommendations series (1). It replaces the previous guideline published in 1996. The goal of the new guidelines is to provide evidencebased recommendations for preventing catheter-related infections. The new document was prepared by a working group led by the Society of Critical Care Medicine, in collaboration with the Infectious Disease Society of America, Society for Healthcare Epidemiology of America, Surgical Infection Society, American College of Chest Physicians, American Thoracic Society, American Society of Critical Care Anesthesiologists, Association for Professionals in Infection Control and Epidemiology, Infusion Nurses Society, Oncology Nursing Society, Society of Interventional Radiology, American Academy of Pediatrics, and the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control. Major areas of emphasis in the new guidelines include (i) education and training of health-care providers who insert and maintain catheters, (ii) use of maximal sterile barrier precautions during central venous catheter (CVC) insertion, (iii) use of a 2% chlorhexidine preparation for skin antisepsis, (iv) avoidance of routine replacement of CVCs as a strategy to prevent infection, and (v) use of antisepticor antibiotic-impregnated short-term CVCs if the rate of infection is high despite adherence to other strategies (ie, education and training, maximum sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). The full guideline, available without charge at http:// www.cdc.gov/mmwr/PDF/RR/RR5110.pdf, is lengthy and includes numerous other recommendations (1). Portions of the new guideline are of particular interest to interventional radiologists, particularly those dealing with CVCs, peripherally inserted central catheters (PICCs), and hemodialysis catheters. Selected recommendations are presented verbatim here, along with selected supporting data, background information, and references.

Guidelines for the prevention of intravascular catheter-related infections

Background: Although many catheter-related bloodstream infections (CR-BSIs) are preventable, measures to reduce these infections are not uniformly implemented. Objective: To update an existing evidenced-based guideline that promotes strategies to prevent CR-BSIs. Data Sources: The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles. Studies Included: Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiological investigations. Outcome Measures: Reduction in CR-BSI, catheter colonization, or catheter-related infection. Synthesis: The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e. education and training, maximal sterile barrier precautions and 2% chlorhexidine for skin antisepsis). Conclusion: Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection. (Am J Infect Control 2002;30:476-89.)

Guidelines for the Prevention of Intravascular Catheter–Related Infections

AbstractThese guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device–Related Infections published in 1996. These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.