Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2020

01-12-2020 | Septicemia | Research

Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study

Authors: Hye Ju Yeo, Dohyung Kim, Mihyang Ha, Hyung Gon Je, Jeong Soo Kim, Woo Hyun Cho

Published in: Critical Care | Issue 1/2020

Login to get access

Abstract

Background

Although the prevention of extracorporeal membrane oxygenation (ECMO) catheter-related infection is crucial, scientific evidence regarding best practices are still lacking.

Methods

We conducted an uncontrolled before-and-after study to test whether the introduction of disinfection with 2% chlorhexidine gluconate (CHG) and 70% isopropyl alcohol (IPA) of the exposed circuits and hub in patients treated with ECMO would affect the rate of blood stream infection (BSI) and microbial colonization of the ECMO catheter. We compared the microbiological and clinical data before and after the intervention.

Results

A total of 1740 ECMO catheter days in 192 patients were studied. These were divided into 855 ECMO catheter days in 96 patients before and 885 ECMO catheter days in 96 patients during the intervention. The rates of BSI were significantly decreased during the intervention period at 11.7/1000 ECMO catheter days before vs. 2.3/1000 ECMO catheter days during (difference 9.4, 95% confidence interval (CI) 1.5–17.3, p = 0.019). Furthermore, the colonization of the ECMO catheter was similarly significantly reduced during the intervention period at 10.5/1000 ECMO catheter days before vs. 2.3/1000 ECMO catheter days during intervention (difference 8.3, 95% CI 0.7–15.8, p = 0.032). Hospital mortality (41.7% vs. 24%, p = 0.009) and sepsis-related death (17.7% vs. 6.3%, p = 0.014) were also significantly decreased during intervention.

Conclusion

Extensive disinfection of exposed ECMO circuits and hub with 2% CHG/IPA was associated with a reduction in both BSI and microbial colonization of ECMO catheters. A further randomized controlled study is required to verify these results.

Trial registration

Appendix
Available only for authorised users
Literature
1.
Kim DW, Yeo HJ, Yoon SH, et al. Impact of bloodstream infections on catheter colonization during extracorporeal membrane oxygenation. J Artif Organs. 2016;19:128–33.CrossRef
2.
Thomas G, Hraiech S, Cassir N, et al. Venovenous extracorporeal membrane oxygenation devices-related colonisations and infections. Ann Intensive Care. 2017;7:111.CrossRef
3.
Biffi S, Di Bella S, Scaravilli V, et al. Infections during extracorporeal membrane oxygenation: epidemiology, risk factors, pathogenesis and prevention. Int J Antimicrob Agents. 2017;50:9–16.CrossRef
4.
5.
Donskey CJ, Deshpande A. Effect of chlorhexidine bathing in preventing infections and reducing skin burden and environmental contamination: a review of the literature. Am J Infect Control. 2016;44(5 Suppl):e17–21.CrossRef
6.
Shah HN, Schwartz JL, Luna G, Cullen DL. Bathing with 2% chlorhexidine gluconate: evidence and costs associated with central line-associated bloodstream infections. Crit Care Nurs Q. 2016;39:42–50.CrossRef
7.
Musuuza JS, Guru PK, O’Horo JC, et al. The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis. BMC Infect Dis. 2019;19:416.CrossRef
8.
Adams D, Quayum M, Worthington T, Lambert P, Elliott T. Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant. J Hosp Infect. 2005;61:287–90.CrossRef
9.
10.
11.
12.
Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49:1–45.CrossRef
13.
American Thoracic Society. Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.
14.
15.
Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977;296:1305–9.CrossRef
16.
Hsu MS, Chiu KM, Huang YT, et al. Risk factors for nosocomial infection during extracorporeal membrane oxygenation. J Hosp Infect. 2009;73:210–6.CrossRef
17.
Glater-Welt LB, Schneider JB, Zinger MM, Rosen L, Sweberg TM. Nosocomial bloodstream infections in patients receiving extracorporeal life support: variability in prevention practices: a survey of the extracorporeal life support organization members. J Intensive Care Med. 2016;31:654–69.CrossRef
18.
Yeo HJ, Yoon SH, Lee SE, et al. Bacterial biofilms on extracorporeal membrane oxygenation catheters. ASAIO. 2018;64:e48–54.CrossRef
19.
Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med. 2004;30:62–7.CrossRef
20.
Tien KL, Sheng WH, Shieh SC, et al. Chlorhexidine Bathing to Prevent Central Line-Associated Bloodstream Infections in Hematology Units: A Prospective, Controlled Cohort Study. Clin Infect Dis. 2020;71:556–63.
21.
Fan CY, Lee WT, Hsu TC, et al. Effect of chlorhexidine bathing on colonization or infection with Acinetobacter baumannii: a systematic review and meta-analysis. J Hosp Infect. 2019;103:284–92.CrossRef
22.
Reagan KA, Chan DM, Vanhoozer G, et al. You get back what you give: decreased hospital infections with improvement in CHG bathing, a mathematical modeling and cost analysis. Am J Infect Control. 2019;47:1471–3.CrossRef
23.
Patel A, Parikh P, Dunn AN, et al. Effectiveness of daily chlorhexidine bathing for reducing gram-negative infections: a meta-analysis. Infect Control Hosp Epidemiol. 2019;40:392–9.CrossRef
24.
O’Horo JC, Silva GL, Munoz-Price LS, Safdar N. The efficacy of daily bathing with chlorhexidine for reducing healthcare-associated bloodstream infections: a meta-analysis. Infect Control Hosp Epidemiol. 2012;33:257–67.CrossRef
25.
Taha M, Kalab M, Yi QL, et al. Biofilm-forming skin microflora bacteria are resistant to the bactericidal action of disinfectants used during blood donation. Transfusion. 2014;54:2974–82.CrossRef
26.
Borer A, Gilad J, Porat N, et al. Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit. J Hosp Infect. 2007;67:149–55.CrossRef
27.
McCambridge J, Sorhaindo A, Quirk A, Nanchahal K. Patient preferences and performance bias in a weight loss trial with a usual care arm. Patient Educ Couns. 2014;95:243–7.CrossRef
28.
Abrams D, Grasselli G, Schmidt M, Mueller T, Brodie D. ECLS-associated infections in adults: what we know and what we don’t yet know. Intensive Care Med. 2020;46:182–91.CrossRef
29.
Jaworski R, Kansy A, Dzierzanowska-Fangrat K, Maruszewski B. Antibiotic prophylaxis in pediatric cardiac surgery: where are we and where do we go? A systematic review. Surg Infect. 2019;20:253–60.CrossRef
30.
O’Horo JC, Cawcutt KA, De Moraes AG, Sampathkumar P, Schears GJ. The evidence base for prophylactic antibiotics in patients receiving extracorporeal membrane oxygenation. ASAIO. 2016;62:6–10.CrossRef
31.
Bull T, Corley A, Lye I, Spooner AJ, Fraser JF. Cannula and circuit management in peripheral extracorporeal membrane oxygenation: an international survey of 45 countries. PLoS One. 2019;14(12):e0227248.CrossRef
32.
Mishra V, Svennevig JL, Bugge JF, Andresen S, et al. Cost of extracorporeal membrane oxygenation: evidence from the Rikshospitalet University Hospital, Oslo, Norway. Eur J Cardio Thoracic Surg. 2010;37(2):339–42.
33.
Angus DC, Linde-Zwirble WT, Clermont G, Griffin MF, Clark RH. Epidemiology of neonatal respiratory failure in the United States: projections from California and New York. Am J Respir Crit Care Med. 2001;164(7):1154–60.CrossRef
Metadata
Title
Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study
Authors
Hye Ju Yeo
Dohyung Kim
Mihyang Ha
Hyung Gon Je
Jeong Soo Kim
Woo Hyun Cho
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03310-w

Other articles of this Issue 1/2020

Critical Care 1/2020 Go to the issue

Research

Two subphenotypes of septic acute kidney injury are associated with different 90-day mortality and renal recovery

Letter

Compression indexes measured by transthoracic echocardiographic might be not accurate without interrupting chest compressions

Review

High-density lipoproteins during sepsis: from bench to bedside

Research Letter

Body temperature correlates with mortality in COVID-19 patients

Commentary

COVID-19: more than a cytokine storm

Research

Corticosteroid therapy for coronavirus disease 2019-related acute respiratory distress syndrome: a cohort study with propensity score analysis