Daily bathing with 4% chlorhexidine gluconate in intensive care settings: a randomized controlled trial

Abstract

Objectives: To investigate whether daily bathing with a soap-like solution of 4% chlorhexidine (CHG) followed by water rinsing (CHGwr) would decrease the incidence of hospital-acquired infections (HAI) in intensive care settings. Methods: Randomized, controlled trial; infectious diseases specialists were blinded to the intervention status. All patients admitted to the Intensive Care Unit (ICU) and to the Post-operative Cardiosurgical Intensive Care Unit (PC-ICU) of the University Hospital of Perugia were enrolled and randomized to the intervention arm (daily bathing with 4% CHGwr) or to the control arm (daily bathing with standard soap). The incidence rate of acquisition of HAI was compared between the two arms as primary outcome. We also evaluated the incidence of bloodstream infections (BSI), central-line-associated BSI (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTI), and 4% CHGwr safety. Results: In all, 449 individuals were enrolled, 226 in treatment arm and 223 in control arm. Thirty-four individuals of the 226 (15%) and 57 (25.6%) suffered from at least an HAI in the intervention and control arms, respectively (p 0.008); 23.2 and 40.9 infections/1000 patient-days were detected in the intervention arm and control arm, respectively (p 0.037). The incidence of all bloodstream infections (BSI plus CABSI) was significantly reduced in the intervention arm (9.2 versus 22.6 infections/1000 patient-days, p 0.027); no differences were observed in the mortality between the two arms. Conclusions: Daily bathing with 4% CHGwr significantly reduced HAI incidence in intensive care settings.

Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double‐blinded randomized controlled trial from the Children's Oncology Group

“…In contrast to the findings of the current study, several trials performed in critically ill adults have demonstrated a reduction in BSI with the use of CHG, [11][12][13][14][15][16][17][18] although results have varied among the 4 randomized controlled trials conducted in this population. 11,13,19,20 Two studies demonstrated a benefit of CHG in reducing BSI 13,11 whereas 2 studies did not.…”

Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections

“…Afonso et al assumed in their meta-analysis that the decline in CLABSI incidence is due to a reduction in commensal Gram-positive skin micro-organisms, making a contamination of the CVC with these pathogens less likely [18]. In line with this theory, Palotto et al found a significant reduction in Gram-positive micro-organisms among bacteria causing CLABSI after implementation of chlorhexidine bathing [19]. This hypothesis is only partly supported by the current study, because there was (apart from an increase in S. marcescens) no change in the relative frequency of causative pathogens.…”

Central‐line‐associated bloodstream infections in a surgical paediatric intensive care unit: Risk factors and prevention with chlorhexidine bathing

“…In our hospital, the 2% non‐alcoholic chlorhexidine (whatever its presentation: foam soap such as Aquaseptic or impregnated wash cloths such as Sage products, Cary, Illinois) was not available while the CHG4% was available as foam soap (4% HibiScrub, Mölnlycke Health Care, United Kingdom). In addition, the literature review did not show the superiority of one formulation over the other in 2014, when the cutaneous decontamination protocol was written . Since then, a meta‐analysis published in 2019 seems to show a superiority of CHG4% compared to CHG2% for the prevention of HAIs …”

“…In addition, the literature review did not show the superiority of one formulation over the other in 2014, when the cutaneous decontamination protocol was written. 13,14 Since then, a meta-analysis published in 2019 seems to show a superiority of CHG4% compared to CHG2% for the prevention of HAIs. 15 The incidence rate of CLABSI observed before and after implementation of our targeted protocol is comparable to rates seen in other PICU studies.…”