使用2% chlorhexidine擦澡在減少重症病患醫療照顧相關感染及預防多重抗藥性菌株移生的應用

Application of 2% Chlorhexidine during Bathing in Critically Ill Patients Reduces Healthcare-associated Infections and Prevents the Colonization of Multi-drug Resistant Organisms

多重抗藥性菌株移生所造成的醫療照護相關感染，會增加病人的住院天數、死亡率、病房成本及醫療人員的負擔，所以預防醫療照護相關感染一直都是醫療機構及世界衛生組織很重視的議題。而根據近期的相關研究，每日使用Chlorhexidine gluconate擦澡可有效降低醫療照護相關感染的感染率、多重抗藥性菌株的移生率、革蘭氏陰性細菌培養陽性率及對methicillin具抗藥性之Staphylococcus aureu（MRSA）與對vancomycin具抗藥性之Enterococcus（VRE）等所造成的醫療照護相關感染的感染率。研究也發現有抗藥性金黃色葡萄球菌移生的血液透析患者，在使用chlorhexidine gluconate擦澡及鼻腔mupirocin軟膏使用後，能有效降低抗藥性金黃色葡萄球菌移生的陽性率。因此使用chlorhexidine gluconate濕巾擦澡以期望能減少病人抗藥性菌皮膚帶原進一步減少醫療照護相關感染。本文回顧以2% chlorhexidine gluconate濕巾擦澡與使用不含抗菌劑紙巾擦澡的病人比較，在降低醫療照護相關感染率的成效。

Healthcare-associated infections caused by multi-drug resistant organisms increase a patient's hospitalization days and mortality, hospital cost, and the workload on the medical staff. Therefore, the prevention of healthcare-associated infections has been a very important topic for medical institutions and the World Health Organization (WHO). According to recent studies, using chlorhexidine gluconate for daily baths can reduce healthcare-associated infection, the colonization rate of multi-drug resistant organisms, positive rate of gram-negative bacterial culture, and healthcare-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), etc. In one study, using chlorhexidine gluconate for bath and mupirocin nasal ointment in the nasal cavity can effectively decolonized methicillin-resistant Staphylococcus aureus in long-term hemodialysis patients. Therefore, using chlorhexidine gluconate wipes for bath are expected to reduce the patient's skin colonization rate of drug-resistant bacteria, and thereby reduce healthcare-associated infections. This article reviews the effectiveness of using 2% chlorhexidine gluconate bath wipes in reducing healthcare-associated infection in patients and compares the effects with those in patients who do not use antimicrobial bath wipes.