Daily Chlorhexidine Gluconate Bathing for Medical Inpatients: Reducing the Incidence of Hospital-Associated Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci
Bibliographic record
Abstract
Background. Chlorhexidine gluconate (CHG) is an antiseptic with activity against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The use of CHG for patient bathing has been shown to be effective in decreasing nosocomial infections in the ICU. Limited evidence exists for CHG bathing on non-ICU wards, where there are significant differences in patient population and nursing workload. Methods. A 6-month prospective study (June 2, 2014–December 2, 2014) on 4 medical inpatient wards at an urban, academic hospital in Vancouver, Canada, was conducted to assess the effectiveness of daily CHG bathing on nosocomial rates of MRSA and VRE. Nosocomial Clostridium difficile (CDI) was also measured as a “control”, because CHG does not have sporicidal activity. Two wards served as the control cohort (using soap/water for bathing), while 2 wards used CHG cloths. Nosocomial MRSA, VRE and CDI cases were defined as patients with positive laboratory findings >3 days after admission, or ≤3 days for patients previously admitted to our hospital in the past 4 weeks. Compliance for wards using CHG cloths was monitored weekly. Average bathing time was based on self-reporting by nursing staff on all 4 wards for soap/water at baseline and for the 2 wards using CHG cloths. Results. Overall, nosocomial rates for MRSA, VRE and CDI were as follows: 33.5, 17.4 and 2.48 per 10,000 inpatient days. A significant reduction in the total number of nosocomial cases between the control and study cohorts for MRSA (15.9 versus 4.5, P = .016) and VRE (30.7 versus 15.6, P = .036) was observed, but not for CDI (2.3 versus 6.7, P = 0.167). Bathing time for nursing staff was 26 minutes (n = 34) with soap and water versus 6 minutes (n = 32) with CHG. Overall compliance with CHG on the study unit was 62%. Conclusion. Despite suboptimal compliance, reduced rates of nosocomial MRSA and VRE were observed in the 2 medical wards that used daily CHG bathing. In addition, use of CHG may help alleviate nursing workload as it decreased bathing time by an average of 20 minutes. Preliminary results suggest that daily CHG bathing outside of the ICU is effective in preventing nosocomial MRSA and VRE. Disclosures. C. F. Lowe, Sage Products: Investigator, Research support; E. Lloyd-Smith, Sage Products: Investigator, Research support; M. G. Romney, Sage Products: Investigator, Research support
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 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".