covid
Buscar en
Infectio
Toda la web
Inicio Infectio Papel de la clorhexidina en la prevención de las infecciones asociadas a la ate...
Información de la revista
Vol. 15. Núm. 2.
Páginas 98-107 (junio 2011)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 15. Núm. 2.
Páginas 98-107 (junio 2011)
Open Access
Papel de la clorhexidina en la prevención de las infecciones asociadas a la atención en salud
Role of chlorhexidine in the prevention of health care related infections
Visitas
10526
Juan José Maya1, Sory Jamil Ruiz1, Robinson Pacheco1, Sandra Liliana Valderrama2, María Virginia Villegas1,
Autor para correspondencia
mariavirginia.villegas@gmail.com

Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Carrera 125 N° 19-225, Cali, Colombia. Teléfono: (572) 555-2638.
1 Centro Internacional de Entrenamiento e Investigaciones Medicas (CIDEIM)
2 Hospital Universitario San Ignacio. Pontificia Universidad Javeriana
Este artículo ha recibido

Under a Creative Commons license
Información del artículo
Resumen
Bibliografía
Descargar PDF
Estadísticas
Resumen

Las infecciones asociadas a la atención en salud son uno de los eventos secundarios más comunes entre los pacientes hospitalizados. Estas infecciones se relacionan con incrementos en la morbilidad, la mortalidad, la estancia hospitalaria y los costos asociados a la atención en salud.

La clorhexidina ha probado ser útil en la prevención de infecciones asociadas a la atención en salud, debido a su amplio espectro antiséptico, su eficacia y su margen de seguridad. Diferentes estudios han demostrado efectividad de la clorhexidina en la prevención de infecciones tales como las del sitio operatorio, la bacteriemia asociada al catéter vascular, la neumonía asociada al respirador, las infecciones maternas y neonatales, y otras infecciones causadas por Staphylococcus aureus. La mayoría de los estudios han encontrando superioridad de este compuesto sobre otros antisépticos, en la prevención y control de infecciones asociadas a la salud.

Palabras clave:
clorhexidina
antiséptico
Staphylococcus aureus
Abstract

Health care related infections are one of the most common adverse events among hospitalized patients. These types of infections are related to an increased morbidity, mortality, hospitalization time, and health care related costs. Chlorhexidine has been proven to be useful for preventing health care related infections due to its wide antiseptic spectrum, effectiveness and safety. Different studies have shown evidence about the effectiveness of chlorhexidine in the prevention of infections related to surgical sites, vascular catheter related bloodstream infections, ventilator associated pneumonia, maternal and neonatal infections and other infections caused by Staphylococcus aureus. Most studies have found superiority of this compound against other antiseptics in the prevention and control of health care related infections.

Key words:
Chlorhexidine
antiseptic
Staphylococcus aureus
El Texto completo está disponible en PDF
Referencias
[1.]
A.M. Milstone, C.L. Passaretti, T.M. Perl.
Chlorhexidine: Expanding the armamentarium for infection control and prevention.
Clin Infect Dis, 46 (2008), pp. 274-281
[2.]
J.M. Boyce, D. Pittet.
Guideline for hand hygiene in health-care settings Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
MMWR Recomm Rep, 51 (2002), pp. 1-45
[3.]
E.L. Larson, A.M. Butz, D.L. Gullette, B.A. Laughon.
Alcohol for surgical scrubbing?.
Infect Control Hosp Epidemiol, 11 (1990), pp. 139-143
[4.]
R.O. Darouiche, M.J. Wall Jr., K.M. Itani, M.F. Otterson, A.L. Webb, M.M. Carrick, et al.
Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis.
N Engl J Med, 362 (2010), pp. 18-26
[5.]
I. Lee, R.K. Agarwal, B.Y. Lee, N.O. Fishman, C.A. Umscheid.
Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection.
Infect Control Hosp Epidemiol, 31 (2010), pp. 1219-1229
[6.]
D.J. Anderson, D.J. Sexton, Z.A. Kanafani, G. Auten, K.S. Kaye.
Severe surgical site infection in community hospitals: Epidemiology, key procedures, and the changing prevalence of methicillinresistant Staphylococcus aureus.
Infect Control Hosp Epidemiol, 28 (2007), pp. 1047-1053
[7.]
I. Levin, J. Amer-Alshiek, A. Avni, J.B. Lessing, A. Satel, B. Almog.
Chlorhexidine and alcohol versus povidone-iodine for antisepsis in gynecological surgery.
J Womens Health (Larchmont.), 20 (2011), pp. 321-324
[8.]
A. Noorani, N. Rabey, S.R. Walsh, R.J. Davies.
Systematic review and meta-analysis of preoperative antisepsis with chlorhexidine versus povidone-iodine in clean-contaminated surgery.
Br J Surg, 97 (2010), pp. 1614-1620
[9.]
G.A. Ayliffe.
Surgical scrub skin disinfection.
Infect Control, 5 (1984), pp. 23-27
[10.]
J. Webster, S. Osborne.
Preoperative bathing or showering with skin antiseptics to prevent surgical site infection.
Cochrane Database Syst Rev, 2 (2007),
[11.]
R.R. Bailey, D.R. Stuckey, B.A. Norman, A.P. Duggan, K.M. Bacon, D.L. Connor, et al.
Economic value of dispensing home-based preoperative chlorhexidine bathing cloths to prevent surgical site infection.
Infect Control Hosp Epidemiol, 32 (2011), pp. 465-471
[12.]
L.G. Bode, J.A. Kluytmans, H.F. Wertheim, D. Bogaers, C.M. Vandenbroucke-Grauls, R. Roosendaal, et al.
Preventing surgical-site infections in nasal carriers of Staphylococcus aureus.
N Engl J Med, 362 (2010), pp. 9-17
[13.]
N. Safdar, J.P. Fine, D.G. Maki.
Meta-analysis: Methods for diagnosing intravascular device-related bloodstream infection.
Ann Intern Med, 142 (2005), pp. 451-466
[14.]
D.G. Maki, M. Ringer, C.J. Alvarado.
Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters.
Lancet, 338 (1991), pp. 339-343
[15.]
N. Chaiyakunapruk, D.L. Veenstra, B.A. Lipsky, S. Saint.
Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: A meta-analysis.
Ann Intern Med, 136 (2002), pp. 792-801
[16.]
J. Valles, I. Fernández, D. Alcaraz, E. Chacón, A. Cazorla, M. Canals, et al.
Prospective randomized trial of 3 antiseptic solutions for prevention of catheter colonization in an intensive care unit for adult patients.
Infect Control Hosp Epidemiol, 29 (2008), pp. 847-853
[17.]
M.E. Rupp, S.J. Lisco, P.A. Lipsett, T.M. Perl, K. Keating, J.M. Civetta, et al.
Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheterrelated infections: A randomized, controlled trial.
Ann Intern Med, 143 (2005), pp. 570-580
[18.]
H. Small, D. Adams, A.L. Casey, C.T. Crosby, P.A. Lambert, T. Elliott.
Efficacy of adding 2% (w/v) chlorhexidine gluconate to 70% (v/v) isopropyl alcohol for skin disinfection prior to peripheral venous cannulation.
Infect Control Hosp Epidemiol, 29 (2008), pp. 963-965
[19.]
T.J. Karpanen, A.L. Casey, B.R. Conway.
Lambert PA, Elliott TS. Antimicrobial activity of a chlorhexidine intravascular catheter site gel dressing.
J Antimicrob Chemother, (2011),
[20.]
L.S. Munoz-Price, B. Hota, A. Stemer, R.A. Weinstein.
Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital.
Infect Control Hosp Epidemiol, 30 (2009), pp. 1031-1035
[21.]
K.J. Popovich, B. Hota, R. Hayes, R.A. Weinstein, M.K. Hayden.
Effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit.
Infect Control Hosp Epidemiol, 30 (2009), pp. 959-963
[22.]
N. Chaiyakunapruk, D.L. Veenstra, B.A. Lipsky, S.D. Sullivan, S. Saint.
Vascular catheter site care: The clinical and economic benefits of chlorhexidine gluconate compared with povidone iodine.
Clin Infect Dis, 37 (2003), pp. 764-771
[23.]
N.P. O’Grady, M. Alexander, E.P. Dellinger, J.L. Gerberding, S.O. Heard, D.G. Maki, et al.
Guidelines for the prevention of intravascular catheter-related infections.
Pediatrics, 110 (2002), pp. e51
[24.]
A.G. Freifeld, E.J. Bow, K.A. Sepkowitz, M.J. Boeckh, J.I. Ito, C.A. Mullen, et al.
Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America.
Clin Infect Dis, 52 (2011), pp. 427-431
[25.]
N.P. O’Grady, M. Alexander, L.A. Burns, E.P. Dellinger, J. Garland, S.O. Heard, et al.
Summary of recommendations: Guidelines for the prevention of intravascular catheter-related infections.
Clin Infect Dis, 52 (2011), pp. 1087-1099
[26.]
C.A. Álvarez, J.A. Cortés, C.H. Gómez, J.A. Fernández, M.P. Sossa, F. Beltrán, et al.
Guías de práctica clínica para la prevención de infecciones intrahospitalarias asociadas al uso de dispositivos médicos.
Infectio, 14 (2010), pp. 292-308
[27.]
M.I. Restrepo, A. Anzueto, A.C. Arroliga, B. Afessa, M.J. Atkinson, N.J. Ho, et al.
Economic burden of ventilator-associated pneumonia based on total resource utilization.
Infect Control Hosp Epidemiol, 31 (2010), pp. 509-515
[28.]
H. Karaoglan, A.N. Yalcin, M. Cengiz, A. Ramazanoglu, D. Ogunc, R. Hakan, et al.
Cost analysis of ventilator-associated pneumonia in Turkish medical-surgical intensive care units.
Infec Med, 18 (2010), pp. 248-255
[29.]
H. Tantipong, C. Morkchareonpong, S. Jaiyindee, V. Thamlikitkul.
Randomized controlled trial and meta-analysis of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia.
Infect Control Hosp Epidemiol, 29 (2008), pp. 131-136
[30.]
A.J. DeRiso, J.S. Ladowski, T.A. Dillon, J.W. Justice, A.C. Peterson.
Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery.
Chest, 109 (1996), pp. 1556-1561
[31.]
F.A. Scannapieco, J. Yu, K. Raghavendran, A. Vacanti, S.I. Owens, K. Wood, et al.
A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients.
Crit Care, 13 (2009), pp. R117
[32.]
T.S. Panchabhai, N.S. Dangayach.
Role of chlorhexidine gluconate in ventilator-associated pneumonia prevention strategies in ICU patients: Where are we headed?.
Crit Care, 13 (2009), pp. 427
[33.]
P. Lumbiganon, J. Thinkhamrop, B. Thinkhamrop, J.E. Tolosa.
Vaginal chlorhexidine during labour for preventing maternal and neonatal infections (excluding group B Streptococcal and HIV).
Cochrane Database Syst Rev, 4 (2004),
[34.]
B. Stade, V. Shah, A. Ohlsson.
Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection.
Cochrane Database Syst Rev, 3 (2004),
[35.]
R.P. Wenzel.
Minimizing surgical-site infections.
N Engl J Med, 362 (2010), pp. 75-77
[36.]
C. Wendt, S. Schinke, M. Wurttemberger, K. Oberdorfer, O. Bock-Hensley, B.H. von.
Value of whole-body washing with chlorhexidine for the eradication of methicillin-resistant Staphylococcus aureus: a randomized, placebo-controlled, double-blind clinical trial.
Infect Control Hosp Epidemiol, 28 (2007), pp. 1036-1043
[37.]
R. Batra, B.S. Cooper, C. Whiteley, A.K. Patel, D. Wyncoll, J.D. Edgeworth.
Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillin-resistant Staphylococcus aureus in an intensive care unit.
Clin Infect Dis, 50 (2010), pp. 210-217
[38.]
B.Y. Lee, A.E. Wiringa, R.R. Bailey, V. Goyal, B. Tsui, G.J. Lewis, et al.
The economic effect of screening orthopedic surgery patients preoperatively for methicillin-resistant Staphylococcus aureus.
Infect Control Hosp Epidemiol, 31 (2010), pp. 1130-1138
[39.]
C. Liu, A. Bayer, S.E. Cosgrove, R.S. Daum, S.K. Fridkin, R.J. Gorwitz, et al.
Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children.
Clin Infect Dis, 52 (2011), pp. e18-e55
[40.]
E.J. Lowbury, H.A. Lilly.
Use of 4 per cent chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection.
Br Med J, 1 (1973), pp. 510-515
[41.]
C.A. Bartzokas, J.E. Corkill, T. Makin, E. Parry.
Comparative evaluation of the immediate and sustained antibacterial action of two regimens, based on triclosan-and chlorhexidine-containing handwash preparations, on volunteers.
Epidemiol Infect, 98 (1987), pp. 337-344
[42.]
J. Tanner, S. Swarbrook, J. Stuart.
Surgical hand antisepsis to reduce surgical site infection.
Cochrane Database Syst Rev, 1 (2008),
[43.]
N. Sivathasan, P.B. Goodfellow.
Skin cleansers: The risks of chlorhexidine.
J Clin Pharmacol, 51 (2011), pp. 785-786
[44.]
P. Beatty, N. Kumar, A. Ronald.
A complicated case of chlorhexidineassociated anaphylaxis.
[45.]
R. Jee, L. Nel, G. Gnanakumaran, A. Williams, E. Eren.
Four cases of anaphylaxis to chlorhexidine impregnated central venous catheters: A case cluster or the tip of the iceberg?.
Br J Anaesth, 103 (2009), pp. 614-615
[46.]
Y.J. Bae, C.S. Park, J.K. Lee, E. Jeong, T.B. Kim, Y.S. Cho, et al.
A case of anaphylaxis to chlorhexidine during digital rectal examination.
J Korean Med Sci, 23 (2008), pp. 526-528
[47.]
E.J. van Zuuren, F. Boer, E.J. Fat, I. Terreehorst.
Anaphylactic reactions to chlorhexidine during urinary catheterisation.
Ned Tijdschr Geneeskd, 151 (2007), pp. 2531-2534
[48.]
A. Ferrarini, M. Baggi, R. Fluckiger, M.G. Bianchetti.
Intraoperative anaphylaxis to a chlorhexidine polymer in childhood.
Paediatr Anaesth, 16 (2006), pp. 705
Copyright © 2011. Asociación Colombiana de Infectología (ACIN)
Opciones de artículo