What I learned at the APIC 43rd Annual Conference in Charlotte, North Carolina Barbara DeBaun, RN, MSN, CIC SFBA APIC Chapter Meeting September 14, 2016

SFBA APIC Should be Proud

Who You Know Matters

Getting Away is Fun

Where You Pee Shouldn’t Matter

Long Lines Lead You to the Promised Land

Determining Appropriate Use of Chlorhexidine to Reduce HAIs Across the Healthcare Delivery Spectrum Tom Talbot MD MPH Associate Professor of Medicine and Health Policy, Vanderbilt University School of Medicine Chief Hospital Epidemiologist, VUMC

Outline Chlorhexidine (CHG) background CHG and healthcare-associated infection (HAI) prevention The downsides of CHG

Studied Uses for CHG for Infection Prevention* Surgical hand scrub General hand cleansing S. aureus decolonization Epidural catheter dressings Vaginal preparations Oral care/gingivitis treatment and prevention And more . . . *Not discussed further in this lecture

Skin prep agent during insertion Local use in insertion site dressings CHG and the Prevention of Central Line-Associated Bloodstream Infections (CLABSIs) Skin prep agent during insertion Local use in insertion site dressings Coating for catheter

Antimicrobial-Impregnated Catheters Two main types Chlorhexidine-silver sulfadiazine 2 generations: 1st: Coated only on external surface of lumen 2nd: Coated on both internal and external surfaces Minocycline-rifampin Several trials with varying outcomes and comparator groups

Antiseptic CVCs 1st generation (external lumen only) Most showed reduction in CVC colonization Only 2 showed CRBSI reduction 2nd generation (both lumens coated) All showed reduction in CVC colonization None showed CRBSI reduction

CHG-Impregnated Dressings Sponge (Biopatch®) Designed to surround catheter at skin insertion site Must be “right side up” Transparent dressing (Tegaderm™ CHG)

CHG and the Prevention of Ventilator-Associated Pneumonia (VAP) Oropharyngeal decontamination  ? Reduces oral flora that may lead to VAP? Generally use a lower concentration of CHG (0.12 to 2%) and formulations (rinse, gel) Varying VAP definitions a challenge when comparing studies

CHG and the Prevention of Surgical Site Infections (SSIs) Major uses = Incision site preparation Preoperative bathing

CHG Pre-Operative Bathing Reductions in skin bacterial colonization in some studies Significant SSI reductions not noted in most studies Different methods and preparations used ? Removed immediately after application ? Use of agents that inactivate CHG

CHG Daily Bathing Goal: Decrease cutaneous bacterial burden Reduced source for nosocomial transmission? Reduced contamination of devices? Various concentrations (2-4%) and formulations used Solution Impregnated washcloths Most data in ICU patients

CHG Daily Bathing Various outcomes assessed in clinical studies: MDRO (MRSA, VRE) acquisition MDRO infection CLABSI Hospital-acquired bloodstream infection (BSI) Catheter-associated UTI (CAUTI) VAP C. difficile Blood culture contamination

CHG Daily Bathing Precise application important Supple L et al ICHE 2015; 36:1095+

CHG Daily Bathing Various outcomes assessed in clinical studies: MDRO (MRSA, VRE) acquisition MDRO infection CLABSI Hospital-acquired bloodstream infection (BSI) Catheter-associated UTI (CAUTI) VAP C. difficile Blood culture contamination

Conclusions: CHG and HAI Prevention CLABSI Insertion site prep Coated CVC Impregnated dressing Daily bathing: ICU VAP Oral care/rinse Surgical Site Infections Skin preparation Pre-op bathing MDRO Control Daily bathing Outside ICU