Rush University Medical Center, Chicago, Illinois, USA.
Infect Control Hosp Epidemiol. 2012 Sep;33(9):889-96. doi: 10.1086/667371. Epub 2012 Jul 23.
Previous work has shown that daily skin cleansing with chlorhexidine gluconate (CHG) is effective in preventing infection in the medical intensive care unit (MICU). A colorimetric, semiquantitative indicator was used to measure CHG concentration on skin (neck, antecubital fossae, and inguinal areas) of patients bathed daily with CHG during their MICU stay and after discharge from the MICU, when CHG bathing stopped.
MICU patients at Rush University Medical Center.
CHG concentration on skin was measured and skin sites were cultured quantitatively. The relationship between CHG concentration and microbial density on skin was explored in a mixed-effects model using gram-positive colony-forming unit (CFU) counts.
For 20 MICU patients studied (240 measurements), the lowest CHG concentrations (0-18.75 μg/mL) and the highest gram-positive CFU counts were on the neck (median, 1.07 log(10) CFUs; [Formula: see text]). CHG concentration increased postbath and decreased over 24 hours ([Formula: see text]). In parallel, median log(10) CFUs decreased pre- to postbath (0.78 to 0) and then increased over 24 hours to the baseline of 0.78 ([Formula: see text]). A CHG concentration above 18.75 μg/mL was associated with decreased gram-positive CFUs ([Formula: see text]). In all but 2 instances, CHG was detected on patient skin during the entire interbath (approximately 24-hour) period (18 [90%] of 20 patients). In 11 patients studied after MICU discharge (80 measurements), CHG skin concentrations fell below effective levels after 1-3 days.
In MICU patients bathed daily with CHG, CHG concentration was inversely associated with microbial density on skin; residual antimicrobial activity on skin persisted up to 24 hours. Determination of CHG concentration on the skin of patients may be useful in monitoring the adequacy of skin cleansing by healthcare workers.
先前的研究表明，用葡萄糖酸氯己定（CHG）进行日常皮肤清洁可有效预防重症监护病房（MICU）的感染。本研究使用比色半定量指示剂来测量在 MICU 住院期间和停止 CHG 沐浴后出院时，每天用 CHG 沐浴的患者颈部、肘窝和腹股沟区域的皮肤 CHG 浓度。
拉什大学医学中心的 MICU 患者。
测量皮肤 CHG 浓度并对皮肤进行定量培养。使用革兰氏阳性菌 CFU 计数的混合效应模型来探索 CHG 浓度与皮肤微生物密度之间的关系。
在 20 名接受研究的 MICU 患者（240 次测量）中，CHG 浓度最低（0-18.75μg/mL）且革兰氏阳性菌 CFU 计数最高的部位是颈部（中位数为 1.07 log(10) CFUs；[公式：见正文]）。沐浴后 CHG 浓度增加，24 小时后下降（[公式：见正文]）。同时，CFU 计数中位数在沐浴前到沐浴后降低（0.78 降至 0），然后在 24 小时后恢复到 0.78 的基线（[公式：见正文]）。CHG 浓度高于 18.75μg/mL 与革兰氏阳性菌 CFU 减少相关（[公式：见正文]）。除 2 例外，在整个沐浴间隔（约 24 小时）期间，CHG 均被检测到存在于患者皮肤上（20 名患者中的 18 名[90%]）。在 11 名出院后接受研究的患者（80 次测量）中，CHG 皮肤浓度在 1-3 天后降至有效水平以下。
在接受每日 CHG 沐浴的 MICU 患者中，CHG 浓度与皮肤微生物密度呈负相关；皮肤残留的抗菌活性可持续长达 24 小时。测定患者皮肤的 CHG 浓度可能有助于监测医护人员皮肤清洁的充分性。
