Daily Bathing with Chlorhexidine-Based Soap and the Prevention of Staphylococcus aureus Transmission and Infection

Abstract

Objective Determine if daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and ICU-acquired S. aureus infection among ICU patients. Design Prospective pre-post-intervention study with control unit Setting 1,250 bed tertiary-care teaching hospital Patients Medical and surgical intensive care unit (ICU) patients Methods Active surveillance for MRSA colonization was performed in both ICUs. In June 2005, a chlorhexidine bathing protocol was implemented in the surgical ICU. Changes in S. aureus transmission and infection rate before and after implementation were analyzed using time-series methodology. Results The intervention unit had a 20.68% decrease in MRSA acquisition after institution of the bathing protocol [pre-intervention 12.64 vs. post-intervention 10.03 cases/1000 patient-days-at-risk (95% CI: −5.19 – −0.04, p = 0.046)]. There was no significant change in MRSA acquisition in the control ICU during the study period [10.97 pre-June 2005 vs. 11.33/1000 patient-days at risk post-June 2005 (95% CI −37.40 – 15.19, p = 0.40)]. There was a 20.77% decrease in all S. aureus (including MRSA) acquisition in the intervention ICU from 2002-2007 [19.73 pre-intervention to 15.63 cases per 1000 patient-days at risk post-intervention (95% CI −7.25 – −0.95, p=0.012)]. The incidence of ICU-acquired MRSA infections decreased by 41.37% in the intervention ICU (1.96 pre-intervention vs. 1.15 infections per 1000 patient-days at risk post-intervention; p=0.001). Conclusions Institution of daily chlorhexidine bathing in an ICU resulted in a decrease in the transmission of S. aureus, including MRSA. These data support the use of routine daily chlorhexidine baths to decrease rates of S. aureus transmission and infections.

The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units

“…All included studies were conducted after 2005 in the United States, except one study in France [25] and one in Mexico [22]. Seven studies occurred in mixed ICUs [7,8,12,15,21,22,24], four in medical ICUs [6,11,14,25], two in surgical ICUs [9,20], one in a general ICU [23], and one in a trauma ICU [10]. For the intervention protocol of the included studies, all studies used 2% CHG-impregnated cloths for bathing except for one that used 4% CHG-based soap [24].…”

“…MRSA acquisition rates were available for eight studies, including one RCT [11] and seven before and after studies [7,10,11,20,21,23,24], which showed a significant reduction in the risks of MRSA acquisition in the CHG bathing group (RR, 0.78; 95% CI, 0.68 to 0.91; p = 0.001) with a low heterogeneity ( I 2 = 12%; p = 0.34) (Fig. 5).…”

Epidemiology of Surgical Site Infection in a Community Hospital Network

“…36 Third, we recommended daily chlorhexidine bathing for all ICU patients. 37,38 DICON did not recommend the routine use of MRSA preoperative screening protocols or the use of decolonization strategies prior to surgery. We cannot quantify the impact that these infection control measures had upon SSI prevalence because DICON hospitals and surgeons did not uniformly adopt each of our infection control recommendations.…”

Topical Decolonization Does Not Eradicate the Skin Microbiota of Community-Dwelling or Hospitalized Adults

“…As a component of routine clinical care, BJH ICU patients receive daily body washes from the neck down with chlorhexidine-based soap (Exidine 4%; Cardinal Health). Specifically, one 4-ounce bottle of 4% chlorhexidinebased soap is added to 4 quarts of water in a bath basin (to a final concentration of 0.125%, which has been proven to be effective at preventing MRSA transmission and infection in ICUs [30]); this solution is applied to the patient with a wash cloth and allowed to air dry (30,31). These chlorhexidine baths are discontinued upon transfer to the general medicine unit.…”