Chlorhexidine在預防醫療照護相關感染的應用及分析

The Role of Chlorhexidine in the Prevention of Health Care-Associated Infections

醫療照護相關感染不但會增加病人住院日數、病人死亡率、也增加了醫療人力負擔及支出。相較於抗生素的使用、隔離措施、手部清潔等策略，使用chlorhexidine沐浴及消毒的方式來預防醫療照護相關感染，不但同時對包含多重抗藥性細菌的多種病菌有效，且更為簡單安全划算，因此逐漸受到重視及討論。根據近期相關研究，每日使用2% chlorhexidine沐浴，採取普遍性的去移生方式，可以有效的減少醫療照護相關血流感染以及病菌的移生率。而抗藥性金黃色葡萄球菌帶原者同時配合chlorhexidine沐浴及鼻腔mupirocin軟膏使用，則可減少手術傷口感染機率。研究也發現，使用chlorhexidine進行口腔消毒，能降低病患的呼吸器相關肺炎發生率。另外，以chlorhexidine-alcohol作為術前消毒預防手術部位感染的效果，優於以povidone-iodine消毒。

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 (MDROs). Compared with other strategies such as contact precautions or hand hygiene, decontamination by chlorhexidine washing seems to be simpler and more cost-effective, as well as a safe strategy for preventing HAIs. According to current studies, daily washing with 2% chlorhexidine and universal decolonization were both effective in reducing hospital-acquired blood stream infections and the acquisition of MDROs. 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 mupirocin ointment and chlorhexidine solutions. Oral decontamination with chlorhexidine reduces the incidence of ventilator-associated pneumonia. Another study reported that preoperative skin cleansing with chlorhexidine-alcohol was found to be more protective against infections than the use of povidone-iodine.