Avondale College NURS30036 Assignment: Chlorhexidine Research Analysis

This nursing assignment critically analyzes four research articles focused on the use of chlorhexidine (CHG) as an antiseptic agent to prevent catheter-associated infections. The articles explore CHG's antimicrobial properties, its effectiveness compared to other antiseptics like povidone-iodine, a...Read More

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NURSING ASSIGNMENT
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Article 1:
According Bouadma, Karpanen & Elliott (2018), Chlorhexidine (CHG) is considered
as the primary choice within the healthcare setting to prevent or reduce the healthcare
associated infections and bear the anti-microbial property. 0.5% of CHG mixed with the
alcohol is considered as the most effective antiseptic that preparing and cleaning the skin
before any invasive procedure of the patient. The research project was conducted to test for
the efficiency of CHG mixed with alcohol for cleaning the skin of the patient before any
invasive procedure.
From the clinical evidence it was suggested that 2% of CGH was mixed with 70% of
the isopropyl alcohol that will act as the skin antiseptic before the short-term arterial,
haemodialysis and central catheters within the patients admitted in ICU on order to reduces
the threat of catheter-associated contamination as compared to the ≤0.5% (w/v) CHG or
povidone-iodine mixed in alcohol. From the result, it is clear that CGH associated and mixed
with alcohol can be used appropriately for every type of skin cleaning before the invasive
procedure in the ICU. The result were positive for the patient who were practicing the use
CGH in the ICU for the preventing any bacterial infection during invasive procedure.
It can be concluded that CGH has extensive antimicrobial activity and also has large
clinical application that is supported with strong evidences to prevent the onset of bacterial
infection before conducting any invasive procedures.
Article 2:
Girard, Comby & Jacques (2012), performed a primary examination that aimed to
recognize the superior antiseptic agents for preventing the central venous catheter (CVC)-
associated infections for the patient admitted to the Intensive care unit (ICU). The researcher
has used different parameters for comparison such as comfort of use, cost and effectiveness

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of the antiseptic agents. The antiseptic agents considered in this study for comparison were
alcohol-based povidone-iodine solution (PVP-IA) and chlorhexidine antiseptic solution
(CBA).
The questionnaire approach was used for identifying and obtaining the result of best
antiseptic agents based on the measurement of CVC infection and colonization frequency for
both PVP-IA and for CBA. The questionnaire list consisted of different question and were
submitted to various hospital pharmacy for understanding and identifying which antiseptics
were best for reducing central venous catheter (CVC)-associated contaminations. This study
has incorporated 806 central venous catheter (CVC).
The result exhibited that switching from alcohol-based povidone-iodine solution
(PVP-IA) to chlorhexidine antiseptic solution (CBA) resulted in significant reduction of
colonization conducted frequency/100 catheter, non-significant reduction of the CVC-
associated bacteraemia/100 catheter days and non-significant reduction concerned with the
CVC-related infection incidence/100 catheter days. The patient provided with PVP-IA were
under enhanced risk of obtaining infection or CVC colonization according to the multivariate
Cox model investigation. Therefore, from this research study, it was evident that CBA were
not recommended for preventing CVC infection due to their reduced cleansing activity.
Article 3:
Fraser et al. (2018), conducted a detail study to examine which prevention strategy
will be beneficial and helpful for preventing the risk of central venous catheters (CVC)-
associated infection in the neonatal units (NNUs). This research study had aimed to assess the
evidence related to infection anticipation strategy for CVCs as suggested under the national
guidelines and relate the prevention strategy for decreasing the threat of central venous
catheters (CVC)-associated contamination in neonatal units.

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The researcher had evaluated the prevention strategies that were majorly used to
reduce the risk of central venous catheters (CVC)-associated infection in the neonatal units
(NNUs) as recommended in the national guidelines. 134 neonatal units (NNUs) were
surveyed in wales and England in order to report the strategies that is used for preventing the
risk of CVCs. The prevention strategies that are used in different NNUs were compared with
the EPIC3 UK guidelines and GRADE approach was further used to evaluate and assess the
prevention practice in the neonates unit.
The result exhibited that poor quality of evidence were seen deporting the CVC care
bundles and 2% of alcoholic chlorhexidine for decontaminating the skin and catheter ports
prior the insertion. Moderate quality of evidence were seen for actively exchanging the CVCs
and also against the chlorhexidine-impregnated coverings. Hence, it can be concluded that
inconsistency for the practice of antiseptics and CVC care bundle in the NNUs had resulted
in poor quality of evidence for the prevention of CVC infection. The requirement of
conducting a clinical trial was concluded from the study.
Article 4:
Scales (2009), had conducted a comprehensive research that will review the different
routes through which the microorganism can contaminate the vascular access devices and
also examine the advantage of chlorhexidine for preventing catheter-associated bloodstream
infections. The research had highlighted that vascular access devices are very crucial in the
contemporary healthcare setting but are related with enhanced risk of contamination that can
be harmful for the patient going through any invasive surgery or procedure.
The researcher had highlighted five different routes of bacterial contamination that
can affect the patient and lead to catheter-associated bloodstream infection (C-RBSI) namely
intraluminal migration, extra luminal migration, haematogenous seeding, contaminated

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infusates and contamination during insertion on the tip of catheter. In this study, the
researcher has also examined to evaluate the difference between the two antiseptic agents for
cleansing the skin before invasive procedure that will aim to reduce the risk of contamination
namely Chlorhexidine gluconate and povidone-iodine.
The result exhibited that Central venous catheters (CVCs) are one of the supremely
important basis of infection leading to hospital-acquired bacteraemia that is eventually
responsible for enhanced rate of hospitalisation and increase in the total cost of healthcare
treatment. From the result of the study it was clear that Chlorhexidine gluconate is 50% more
operative in reducing the catheter-associated bloodstream infections as linked to the
povidone-iodine for cleaning the skin before any invasive procedure. Hence, chlorhexidine-
founded cleansing products are widely used within the healthcare setting for regular clinical
practice.
Conclusion
This study has completely focused on the catheter-associated infections that affects
large number of patients who are undergoing any invasive procedure. Four different research
articles were considered to identify the best preventive strategy for decreasing the threat of
contamination in the patient. All the four researchers have conducted an extensive research to
identify the preventive strategy and the use of antiseptics that will aim to reduce the enhanced
risk of infection. From all the four research study, the antiseptic Chlorhexidine (CHG) is
measured as the supremely beneficial and operative antiseptic in decreasing the catheter-
associated infections for different types of patients who are admitted to ICU or even for
neonates. Different form of Chlorhexidine (CHG) were used such as Chlorhexidine mixed
with alcohol, Chlorhexidine antiseptic solution and Chlorhexidine gluconate and each form

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were exhibited as the most beneficial agent that can be applied to the skin for cleansing the
skin before any types of invasive surgery.
References
Bouadma, L., Karpanen, T., & Elliott, T. (2018). Chlorhexidine use in adult patients on
ICU. Intensive care medicine, 44(12), 2232-2234. https://doi.org/10.1007/s00134-
018-5137-5
Fraser, C., Harron, K., Dalton, L., Gilbert, R., Oddie, S. J., & PREVAIL Study. (2018).
Variation in infection prevention practices for peripherally inserted central venous
catheters: A survey of neonatal units in England and Wales. PloS one, 13(11),
e0204894. https://doi.org/ 10.1371/journal.pone.0204894
Girard, R., Comby, C., & Jacques, D. (2012). Alcoholic povidone-iodine or chlorhexidine-
based antiseptic for the prevention of central venous catheter-related infections: in-use
comparison. Journal of infection and public health, 5(1), 35-42.
10.1016/j.jiph.2011.10.007
Scales, K. (2009). Correct use of chlorhexidine in intravenous practice. Nursing
standard, 24(8), 41-47. https://go.galegroup.com/ps/anonymous?id=GALE
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