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1 85 Chlorhexidine 在預防醫療照護相關感染的應用及分析林口長庚醫院兒童感染科 2% 2014:24: alcohol povidone-iodine 感控雜誌關鍵詞 : 前言 ) (multidrug-resistant organisms, [1] (03)

2 86 Chlorhexidine 在預防醫療照護相關感染的應用及分析 (endogenous organisms) / () (decontamination) 2% gluconate (2% ) [2-6] 2011 (membrane disruption) [8,9] [10] Methicillin-resistant Staphylococcus aureus (MRSA) Vancomycin-resistant enterococci (VRE) [11] -based [7] 0.5% (residual antibacterial activity) 48 Chlorhexidine gluconate () 介紹 Chlorhexidine -- (Imperial Chemical Industries) (hibitane) cetrimide cetrimide (Savlon) gluconate (microbial burden) [12] 近期應用相關研究的使用方式 ) [2] Climo MW ( 感染控制雜誌

3 陳郁文陳志榮 87 表一不同研究中, 消毒液使用的濃度方式對象以及所預防感染的成效消毒液濃度與消毒方式接受消毒對象預防感染成效出處每日使用 2% 浸漬加護病房及骨髓移植中與使用不含抗微生物製劑的浴巾 Climo et al. N Engl J 的浴巾沐浴心的病患比較, 得到 multidrug-resistant Med 2013;368: organisms 醫療照護相關血流感 [2] 染的機率, 分別下降了 23% 以及 28% 每天兩次鼻腔 2% 重症加護病房病患與介入前的基準比較, 任何病原 Huang et al. N Engl J 藥膏使用及體引起血流感染的風險比 (hazard Med 2013;368:2255- 每日 2% 浸漬毛 ratios) 降低至 0.78 ( 篩檢後去移生 65 [3] 巾 (Sage products) 沐浴組 targeted decolonization) 與 0.56 ( 不篩檢逕行去移生 universal decolonization) 2% 鼻腔藥膏鼻腔 S. aureus 帶原之內與使用安慰劑比較, 預防術後傷 Bode et al. N Engl J 以及 (40 mg/ml) 肥科及外科病房患者口感染, 尤其是深部手術部位感 Med 2010;362(1):9- 皂使用染的效果最為明顯, 共下降了 17 [4] 79% (relative risk, 0.21; 95% CI, 0.07 to 0.62) 使用 2%-- 接受 clean-contaminated 術後 30 天內手術部位感染率, Darouiche et al. N 70% alcohol 或是 10% surgery 之成人病患 -alcohol 組的整體 Engl Med 2010; povidone-iodine 進行術感染率明顯低於 povidone-iodine 362(1);18-26 [5] 前皮膚消毒 (scrub and 組 (9.5% vs. 16.1%) paint) 以 2% 或須連續使用呼吸器達和安慰劑相比, 每日發生 ventilator- Koeman et al. Am J /colistin 48 小時以上的加護病 associated pneumonia 的危險性在 Respir Crit Care Med (2%/2%) 藥劑進行病患房病人及 /colistin 2006;173: [6] 口腔消毒, 六小時一次組都有減少 (65%, P = for and 55%, P = for /colistin); /colistin 組的口腔革蘭氏陰性及陽性菌移生都有明顯減少縮寫 :, gluconate 2% 7,727

4 88 Chlorhexidine 在預防醫療照護相關感染的應用及分析 2% 23% ( 5.10 vs P = 0.030) 28% ( 4.78 vs P = 0.007) 2% Huang SS ( ) [3] (targeted) (universal) (decolonization) (pragmatic, cluster-randomized trial) for all groups) intervention period baseline period (hazard ratios) 0.99 ( 4.1 vs. 4.2) 0.78 ( 3.7 vs. 4.8) 0.56 ( 3.6 vs. 6.1) MRSA 2% ICU MRSA ICU MRSA (screening and isolation) ( MRSA ) ( ) 43 (intervention period 74 ICU 74,256 ) intervention period baseline period MRSA (Modeled hazard ratios) 3.2 vs vs vs. 3.4 (P = 預防的感染種類 (ventilator-associated pneumonia, VAP) Bode LG ( ) [4] PCR 感染控制雜誌

5 陳郁文陳志榮 89 6,771 1,251 1,270 S. aureus (88%) (intention-totreat analysis) PCR S. aureus methicillin S. aureus - 3.4% (17/504 ) 7.7% (32/413 ) ( % 0.23~0.75) Mupirocin- (, 0.21; 95% 0.07~0.62) (P = 0.005) CHX 128 CHX/COL VAP CHX CHX/COL (65%, P = for CHX and 55%, P = for CHX/COL) CHX/COL CHX CHX/COL CHX CHX/COL VAP COL CHX VAP Koeman M ( ) [6] (CHX, 2%) CHX/colistin (CHX/COL, 2%/2%) VAP 和不同消毒劑的效果比較 Darouiche RO [5] clorhexidinealcohol povidone-iodine (clean- 48 contaminated surgery) CHX, clorhexidine-alcohol povidone- CHX/COL, (PLAC) iodine (scrub and ( paint) 30 ) 849

6 90 Chlorhexidine 在預防醫療照護相關感染的應用及分析 ( 409 -alcohol 440 povidone-iodine ) (intention-to-treat analysis) Chlorhexidine-alcohol povidone-iodine (9.5% vs. 16.1%; P = 0.004;, 0.59; 95%, 0.41~0.85) Chlorhexidine-alcohol (4.2% vs. 8.6%, P = 0.008) (1% vs. 3%, P = 0.050) povidone-iodine / (4.4% vs. 4.5%) -alcohol povidone-iodine 結語 (CDC) 參考文獻 1. Klevens RM, Edwards JR, Richards CL Jr, et al: Estimating health care-associated infections and deaths in U.S. hospitals, Public Health Rep 2007;122: Climo MW, Yokoe DS, Warren DK, et al: Effect of daily bathing on hospitalacquired infection. N Engl J Med 2013;368: Huang SS, Septimus E, Kleinman K, et al: Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368: Bode LG, Kluytmans JA, Wertheim HF, et al: Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362: Darouiche RO, Wall MJ Jr., Itani KM, et al: Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl Med 2010;362: Koeman M, van der Ven AJ, Hak E, et al: Oral decontamination with reduces the incidence of ventilator-associated pneumonia. Am J Respir Crit Care Med 2006;173: Naomi P.O Grady, M.D, Mary Alexander, R.N, et al: Center for Disease Control and Prevention: 2011 Guidelines for the Prevention of Intravascular Catheter-Related Infections. hicpac/bsi/bsi-guidelines html 8. Kuyyakanond T, Quesnel LB: The mechanism of action of. FEMS Microbiol Lett 1992;100: Barrett-Bee K, Newboult L, Edwards S: The membrane destabilising action of the antibacterial agent. FEMS Microbiol Lett 1994;119: Emilson CG: Susceptibility of various microorganisms to. Scand J Dent Res 1977;85: Hammond SA, Morgan JR, Russell AD: Comparative susceptibility of hospital isolates of gram-negative bacteria to antiseptics and disinfectants. J Hosp Infect 1987;9: Denton GW. Chlorhexidine. In: Block SS, ed. Disinfection, sterilization, and preservation. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2001; 感染控制雜誌

7 陳郁文陳志榮 91 The Role of Chlorhexidine in the Prevention of Health Care-Associated Infections Yu-Wen Chen, Chih-Jung Chen Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Tau-Yuan, Taiwan Health care-associated infections (HAIs) increases the duration of hospitalization and mortality rates as well as the burden on health care personnel and expenses. Chlorhexidine is an aseptic agent with broad-spectrum activity against many organisms including multidrug-resistant organisms (). Compared with other strategies such as contact precautions or hand hygiene, decontamination by washing seems to be simpler and more costeffective, as well as a safe strategy for preventing HAIs. According to current studies, daily washing with 2% and universal decolonization were both effective in reducing hospital-acquired blood stream infections and the acquisition of. The incidence of surgical-site Staphylococcus aureus infections acquired in the hospital can be reduced by rapid screening on admission and decolonization of nasal cavities with ointment and solutions. Oral decontamination with reduces the incidence of ventilator-associated pneumonia. Another study reported that preoperative skin cleansing with -alcohol was found to be more protective against infections than the use of povidone-iodine. Key words:

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ºî½×2-p174-184 174 美國感染症醫學會 Methicillin 抗藥性金黃色葡萄球菌治療指引李倩瑜 1 鄭舒倖 2 行政院衛生署桃園醫院 1 小兒科 2 感染科 (IDSA) 2011 methicillin (methicillin-resistant Staphylococcus aureus; MRSA) (practice guidelines)[1]