Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection

Abstract

BACKGROUND Results of previous single center observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections (HABSIs) and acquisition of multidrug-resistant organisms (MDROs). METHODS We conducted a multicenter, cluster randomized, non-blinded crossover trial to evaluate the effect of daily bathing with chlorhexidine impregnated washcloths on the acquisition of MDROs and incidence of HABSIs. Nine intensive care and bone marrow transplant units in 6 hospitals were randomly assigned to bathe patients with either 2% no-rinse chlorhexidine-impregnated or non-antimicrobial washcloths for a six-month period, exchanged for the alternate product during the subsequent six months. The incidence rates of acquisition of MDRO and HABSI rates were compared between the two time periods by Poisson regression analysis. RESULTS A total of 7735 patients were enrolled during the study. The overall MDRO acquisition rate was 21% lower when chlorhexidine bathing was used (5.10 cases per 1000 patient days) than when non-antimicrobial washcloths were used (6.60 cases per 1000 patient days, p=0.028). The overall HABSI rate was 31% lower when chlorhexidine was used (4.45 cases per 1000 patient days) than when non-antimicrobial cloths were used (6.60 cases per 1000 patient days, p=0.007) No serious skin reactions were noted in either study period. CONCLUSIONS Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risk of acquiring MDROs and developing HABSI.

Association of Length of Stay With Contamination of Multidrug-Resistant Organisms in the Environment and Colonization in the Rectum of Intensive Care Unit Patients in China

“…As stated by the authors, the finding of higher rates of SSIs during warmer months had been previously reported, [2][3][4][5] and the current work further corroborates such observation. As a result, the most important question is perhaps no longer whether seasonal variation in SSIs can occur, but rather, what is the basis for this observation?…”

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

“…129,130 A multicenter, clusterrandomized, non-blinded crossover trial that included patients in HCT units found that daily bathing with chlorhexidineimpregnated washcloths significantly reduced acquisition of MDR organisms and development of hospital-acquired CLABSIs, particularly those caused by gram positive bacteria and fungi. 131 Current clinical trials are evaluating whether receipt of daily chlorohexidine topical skin wipes for 90 days decreases CLABSI rates in children after allo-HCT.…”

Management of Infections in Critically Ill Patients

“…Milstone et al [5] demonstrated a 36% decrease in the incidence of bacteremia in children given daily CHG bathing, with most of the decrease seen in patients with catheterassociated infections (32%). Climo et al [6] in a multicenter, randomized controlled trial of bathing with CHG in adults, found a reduction of 28% in the risk of hospitalacquired infection, as well as a 31% lower rate of primary BSI and a 90% reduction in catheter-associated infections, in comparison with the rates of these conditions in a control group (0.89 with CHG bathing vs. 1.76 in the control group, p = 0.05). In BSI, there was a significant reduction in numbers of gram-positive organisms with CHG bathing (46% in children and 56% in adults), and such bathing also significantly reduced colonization with vancomycin-resistant enterococci (VRE) and MRSA in adults.…”