Journal of Korean Academy of Nursing

Review Paper

Effect of 2% Chlorhexidine Bathing on the Incidence of Hospital-Acquired Infection and Multidrug-Resistant Organisms in Adult Intensive Care Unit Patients: Systematic Review and Meta-Analysis: Seo, Jisu , Song, Rhayun; J Korean Acad Nurs 2021;51(4):414-429. Published online August 31, 2021; DOI: https://doi.org/10.4040/jkan.21046

Purpose
This systematic review and meta-analysis analyzed the effects of 2% chlorhexidine bathing on the incidence of hospital-acquired infection (HAI) and multidrug-resistant organisms (MDRO) in adult intensive care units.
Methods
PubMed, CINAHL, Cochrane library, and RISS database were systematically searched, and 12 randomized studies were included in the analysis. Comprehensive Meta-Analysis version 3.0 was used to calculate the effect size using the odds ratio (OR) and a 95% confidence interval (CI). Subgroup analysis was performed according to the specific infection and intervention types.
Results
In general, 2% chlorhexidine bathing has a significant effect on the incidence of HAI (OR, 0.59; 95% CI, 0.40~0.86) and MDRO (OR, 0.52; 95% CI, 0.34~0.79). Subgroup analyses show 2% chlorhexidine bathing is effective in bloodstream infections (OR, 0.51; 95% CI, 0.39~0.66) but not for urinary tract infections, ventilator-associated pneumonia infections, and Clostridium difficile infections. Moreover, 2% chlorhexidine bathing alone or its combination with other interventions has a significant effect on the incidence of HAI and MDRO (OR, 0.59; 95% CI, 0.38~0.92).
Conclusion
This meta-analysis reveals that 2% chlorhexidine bathing significantly reduces the incidence of HAI and MDRO in intensive care units. The effect of 2% chlorhexidine bathing on pediatric patients or patients at general wards should be further assessed as a cost-effective intervention for infection control.

Citations

Citations to this article as recorded by

Implementation of 2% Chlorhexidine Bathing to Reduce Healthcare-Associated Infections Among Patients in the Intensive Care Unit
Hsu-Liang Chang, Tzu-Ying Liu, Po-Shou Huang, Chin-Hwan Chen, Chia-Wen Yen, Hui-Zhu Chen, Shin-Huei Kuo, Tun-Chieh Chen, Shang-Yi Lin, Po-Liang Lu
Microorganisms.2025; 13(1): 65. CrossRef
Trends in central line-associated bloodstream infections in pediatric intensive care units: a single-center study
Yu Gyoung Bak, Won Kyoung Jhang
Archives of Pediatric Critical Care.2024; 2(2): 96. CrossRef
A Systematic Review of Antibiotic Resistance Trends and Treatment Options for Hospital-Acquired Multidrug-Resistant Infections
Walter Y Agyeman, Aakash Bisht, Ankit Gopinath, Ameer Haider Cheema, Keyur Chaludiya, Maham Khalid, Marcellina Nwosu, Srujana Konka, Safeera Khan
Cureus.2022;[Epub] CrossRef

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Original Articles

The Incidences of Catheter Colonization and Central Line-Associated Bloodstream Infection According to Tegaderm vs. Chlorhexidine Gluconate (CHG)-Tegaderm Dressing: Kim, Eunji , Lee, Haejung; J Korean Acad Nurs 2020;50(4):541-553. Published online August 31, 2020; DOI: https://doi.org/10.4040/jkan.19215

Abstract PDF

Purpose
In spite of the recent application of a general infection control method, central line-associated infections is still relatively high in Korea. Central line bundle with Chlorhexidine gluconate (CHG) tegaderm dressing was reported to be effective in reducing catheter colonization and central line-associated bloodstream infections (CLABSI). Therefore, this study aimed to examine the incidences of catheter colonization occurrence and CLABSI while using Tegaderm vs. CHG Tegaderm dressings.
Methods
We used a descriptive design. 400 patients who had central venous catheters were selected from four hospitals in the Korean National Healthcare-associated Infections Surveillance System. Of all subjects, 200 used Tegaderm ^TM (Tegaderm group), and the remaining 200 used CHG Tegaderm (CHG Tegaderm group) dressing at the catheter insertion site. Data were analyzed using the c 2 test or Fisher’s exact test, t-test, and logistic regression analysis using SPSS WIN 21.0.
Results
In the Tegaderm and CHG Tegaderm groups, CLABSI incidences were 5.89 and 1.79 per 1,000 catheter-days, catheter colonization incidences were 3.93 and 1.43 per 1,000 catheter-days, and central line bundle compliance rates were 26.0% and 49.0%, respectively. Catheter colonization risk factors were ‘reinsertion after failure’ and ‘Tegaderm dressing’ at the central line insertion site. CLABSI risk factors were ‘incomplete performance of 7 central line bundle items’ and ‘Tegaderm dressing’ at the central line insertion site.
Conclusion
A further prospective study is needed to examine the effects of central line bundle with CHG Tegaderm dressing, avoiding central line reinsertion after failure, and improving the bundle compliance in reducing catheter colonization and CLABSI.

Citations

Citations to this article as recorded by

Effects of organizational and individual factors on nurses’ practice of central line-associated bloodstream infection prevention
Min Hee Kim, Jeong Sil Choi
American Journal of Infection Control.2024; 52(4): 443. CrossRef
Nurse-led intervention to improve oral mucosal health of intubated patients in the intensive care unit: A prospective study
Ching-Ching Lin, Jen-Jiuan Liaw, Chung-Hsing Li, Li-Chin Chen, Chin-Yen Han
American Journal of Infection Control.2024; 52(8): 900. CrossRef
Evidence-based care combined with chlorhexidine gluconate antimicrobial dressing in the prevention of peritoneal dialysis catheter-associated infections
Zuping Wang, Zhang Lin, Fayiza Aikelamu, Gulixian Tuerhong
Materials Express.2024; 14(3): 491. CrossRef
Risk Factors and Prevention of Central Venous Catheter-Related Bloodstream Infection in Intensive Care Unit
文慧刘
Advances in Clinical Medicine.2022; 12(04): 3487. CrossRef

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The Effect of Dongchimi Juice Containing Kimchi Lactobacillus on the Oral Health of Patients at a Long-Term Care Hospital: Comparison with Chlorhexidine Solution: Seung-Ah Lee, Dongsuk Lee; J Korean Acad Nurs 2017;47(4):540-550. Published online January 15, 2017; DOI: https://doi.org/10.4040/jkan.2017.47.4.540

Abstract PDF

Abstract Purpose

The aim of this study was to identify the effect of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent and to compare it with that of chlorhexidine solution (0.12% dilution).

Methods

This study employed a pretest-posttest experimental design in which a single group of patients was exposed to two different treatments over a period of time. The study included 32 patients hospitalized at a longterm care hospital in Korea. Data were collected between August 12, 2016 and September 28, 2016. The patients first used chlorhexidine solution as an oral care agent for 1 week. After an interval of 2 weeks, they used Dongchimi juice for 1 week. Each agent was applied 2 times a day depending on the protocol. The oral status of the patients was measured using Beck's Oral Exam Guide (OEG) scores. The number of pathogens in the oral cavity was counted by culture, and the patients’ subjective satisfaction score for each oral agent was measured using a visual analogue scale. T-test and Mann-Whitney test were performed to identify significant differences between Dongchimi juice and chlorhexidine solution by using PASW Statistics for Windows, Version 18.0 (SPSS Inc., Chicago, IL, USA).

Results

The OEG score was not statistically different with the use of chlorhexidine solution and Dongchimi juice. However, decreasing number of pathogens and the subjective satisfaction score were higher with Dongchimi juice than with the chlorhexidine solution.

Conclusion

These findings support the use of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent for Korean patients.

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Effect of Honey-based Oral Care on Oral Health of Patients With Stroke Undergoing Rehabilitation: A Randomized Controlled Trial
A-Ra Cho, Hyunmi Son, Gyumin Han
Asian Nursing Research.2024; 18(3): 215. CrossRef
Health Benefits of Kimchi, Sauerkraut, and Other Fermented Foods of the Genus Brassica
Sabina Fijan, Polona Fijan, Lei Wei, Maria L. Marco
Applied Microbiology.2024; 4(3): 1165. CrossRef
The impact of aromatherapy-based oral care on oral conditions, salivary pH, and halitosis in older adults with dementia: Pilot study
Ae Kyung Chang, Bo kyoung Kim, Ah Young Kim
Geriatric Nursing.2023; 53: 109. CrossRef
Effects of Oral Probiotics on Subjective Halitosis, Oral Health, and Psychosocial Health of College Students: A Randomized, Double-Blind, Placebo-Controlled Study
Dong-Suk Lee, Myoungsuk Kim, Seoul-Hee Nam, Mi-Sun Kang, Seung-Ah Lee
International Journal of Environmental Research and Public Health.2021; 18(3): 1143. CrossRef
Reduction of Halitosis by a Tablet ContainingWeissella cibariaCMU: A Randomized, Double-Blind, Placebo-Controlled Study
Dong-Suk Lee, Seung-Ah Lee, Myoungsuk Kim, Seoul-Hee Nam, Mi-Sun Kang
Journal of Medicinal Food.2020; 23(6): 649. CrossRef

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Evaluation of a Waterless, Scrubless Chlorhexidine Gluconate/Ethanol Surgical Scrub and Povidone-Iodine for Antimicrobial Efficacy: Jeong Sil Choi; Journal of Korean Academy of Nursing 2008;38(1):39-44. Published online February 28, 2008; DOI: https://doi.org/10.4040/jkan.2008.38.1.39

Abstract PDF

Purpose

The purpose of this study was to compare 1% chlorhexidine-gluconate/61% ethanol (CHG/Ethanol) emollient and 7.5% povidone-iodine (PVI) scrub for antimicrobial,residual effect, and skin condition.

Methods

CHG/Ethanol emollient hand hygiene was performed waterless, and brushless by operating doctors and nurses (N=20). PVI hand washing was performed with water and a brush (N=20) for 5 min. The subjects were asked to press their left hand in hand-shaped agar before a surgical scrub, immediately after a surgical scrub and after the operation. The amount of isolated microorganisms were calculated by counting the number of divided areas(1×1 cm, 160 cell) which were culture positive in the hand culture plate. The skin condition was evaluated.

Results

The antimicrobial count of CHG/Ethanol emollient and PVI immediately post surgical scrub was 0.0 vs. 4.1 (p>.05), and after the operation was 0.1 vs. 37.8 (p>.05)respectively. The Residual effect of CHG/Ethanol emollient immediately post surgical scrub and after the operation were 0.0 vs. 0.1 (p>.05), and PVI were 4.1 vs. 37.8 (p>.05)respectively. The skin condition and satisfaction of CHG/Ethanol emollient was higher than PVI (p<.05).

Conclusion

The antimicrobial effect between CHG/Ethanol emollient and PVI were the same. Considering skin condition, satisfaction and allergic reaction CHG/Ethanol emollient for surgical scrub is recommended in Korea.

Citations

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Two-Layer Wound Sealing before Surgical Hand Washing for Surgeons with a Minor Cut Injury on the Hand
Chan Yoon, Hyun Sik Gong, Jung Soo Park, Hyun Sik Seok, Jin Woo Park, Goo Hyun Baek
Surgical Infections.2019; 20(5): 390. CrossRef
The Efficacy of Chlorhexidine in Hemodialysis Vascular Access Device Disinfection
Ji-Hyun Yang, Young-Mi Yu, Min-Gyeong Yu, Sung-Mi Moon, Sue-Jean Park
Quality Improvement in Health Care.2017; 23(1): 55. CrossRef

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