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 and the acquisition of multidrug-resistant organisms (MDROs).

Methods: We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine-impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis.

Results: A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period.

Conclusions: Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired bloodstream infections. (Funded by the Centers for Disease Control and Prevention and Sage Products; ClinicalTrials.gov number, NCT00502476.).

Figure 1. Reductions in primary bloodstream infections observed with the use of daily chlorhexidine bathing

Incidence rates of hospital acquired primary bloodstream infections are shown among units utilizing daily bathing with either Chlorhexidine impregnated washcloths (black) or non-antimicrobial washcloths (gray).

Figure 2. Kaplan–Meier Estimates of Time to Primary Bloodstream Infections

The cumulative probability of developing a primary bloodstream infection is compared for patients who received Chlorhexidine based bathing (gray) to Controls (Black). The overall protective efficacy of chlorhexidine bathing was 30% (p=0.0158). The inset graph shows a more detailed version of the larger graph with a probability up to 0.25.