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

Abstract PDF: 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.

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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.

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2 Web of Science

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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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.

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