1. 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

2. SFBA APIC Should be Proud

3. Who You Know Matters

4. Getting Away is Fun

5. Where You Pee Shouldn’t Matter

6. Long Lines Lead You to the Promised Land

7. 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

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

9. 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

10. 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

11. 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

12. 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

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

14. 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

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

16. 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

17. 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

18. 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

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

20. 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

21. 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