Assessment of Chlorhexidine Gluconate (CHG) Resistance in the Setting of Suboptimal Compliance of CHG Use on Medical Inpatient Units
Bibliographic record
Abstract
Background. Patient bathing with chlorhexidine gluconate (CHG) is being increasingly used as a horizontal approach to prevent nosocomial infections. Bathing compliance is critical to ensure the effectiveness of this approach, and poor compliance may result in the development of CHG resistance. After trialing CHG cloths on medical inpatients in an urban, academic hospital, compliance was estimated at 62%. This study sought to determine whether resistance was induced in the context of suboptimal compliance. Methods. A 6-month prospective study of CHG on 4 medical wards was conducted from 2 June to 2 December 2014, with 2 wards serving as controls, at an urban, academic hospital in Vancouver, Canada. All nosocomial isolates of methicillin-resistant Staphylococcus aureus (MRSA) from any clinical site [>3 days after admission or ≤3 days with a previous admission in the past 4 weeks], as well as all blood cultures positive for methicillin-susceptible Staphylococcus aureus (MSSA) identified >3 days after admission were included. For patients with multiple isolates, only the first isolate was tested. An in-house developed real-time PCR for the qacA/B and smr genes was utilized. Statistical analysis was based on Fisher's exact test. Results. 21 S. aureus isolates were identified during the study period, including 19 MRSA and 2 MSSA. Of the 21 isolates, 6 were recovered from the intervention wards and 15 from the control wards. One MRSA isolate (sputum) was positive for qacA/B and 1 MSSA isolate (blood) was positive for smr on the CHG intervention wards. For patients on the intervention unit, median time to identification of a nosocomial MRSA was 7 days (estimated time of potential exposure to CHG use on the unit). No qacA/B or smr positive isolates were identified on the control wards (2/6 versus 0/15, p = 0.07). Conclusion. No significant difference in the detection of qacA/B and smr genes were identified in S. aureus recovered from the intervention wards utilizing CHG, despite a compliance of 62% over a 6-month period. However, continued monitoring for resistance is required, particularly for non-ICU settings in which selection of resistant strains may theoretically occur due to the likelihood of suboptimal compliance. Disclosures. C. F. Lowe, Sage Products: Grant Investigator, Research grant; G. Ritchie, Sage Products: Investigator, Research grant; E. Lloyd-Smith, Sage Products: Investigator, Research grant; M. G. Romney, Sage Products: Investigator, Research grant.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".