[Effects of Chlorhexidine Gluconate Bathing Applied to Cancer Patients on MRSA and VRE Colonization: A Cross-Over Design Study].

Abstract

Evidence shows that bathing with chlorhexidine gluconate (CHG) solution reduces the colonization of microorganisms that cause healthcare-associated infections (HAIs). The aim of this study was to evaluate the effects of CHG bath on MRSA and VRE colonization in cancer patients hospitalized in the intensive care unit (ICU). This crossover design study compared standard soap + water baths and 2% CHG baths in cancer patients. Between September 2018 and July 2019, 78 patients were divided into two arms. Patients in the first arm were washed with soap + water for the first three days, followed by 2% CHG for three days. Interventions were administered to patients in the second arm in reverse order. During the control and intervention periods, a washout day was left between bath applications. Swab samples were taken from the nasal, groin and rectal areas before and after bathing. Samples inoculated on sheep blood medium were examined after 16-18 hours of incubation. Gram-positive isolates with positive catalase and coagulase tests were identified as Staphylococcus aureus. Methicillin resistance was determined by disk diffusion test using cefoxitin discs on Mueller-Hinton agar and confirmed by real-time PCR (Rt-PCR) BD MAX MRSA XT test (BD Diagnostics, BD-MAX system, Canada) showing the presence of mecA gene. Samples inoculated on chromID® VRE selective medium were examined after 24 hours of incubation. The suspicious colonies were identified as Enterococcus faecium by API-ID Strep. Vancomycin resistance was confirmed by Rt-PCR VIASURE test (BD Diagnostics, BD-MAX system, Amsterdam) for the presence of vanA and vanB genes. MRSA colonization was detected in six patients and VRE colonization was detected in nine patients. After starting the CHG bath, nasal MRSA colonization decreased in the first arm. When the arms were compared, MRSA colonization in nasal samples and VRE colonization in rectal samples were found to be higher in the first arm than in the second arm. Bathing practices in the ICUs are essential in preventing HAIs, which is one of the patient safety problems. The results of this study show that daily bathing with 2% CHG reduces nasal MRSA and rectal VRE colonization in cancer patients in the ICU.