Effect of daily chlorhexidine bathing on hospital-acquired infection

N Engl J Med. 2013 Feb 7;368(6):533-42. doi: 10.1056/NEJMoa1113849.

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.).

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Infective Agents, Local / therapeutic use*
  • Bacteremia / epidemiology
  • Bacteremia / microbiology
  • Bacteremia / prevention & control*
  • Baths*
  • Chlorhexidine / therapeutic use*
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control*
  • Cross-Over Studies
  • Drug Resistance, Multiple, Bacterial*
  • Enterococcus / drug effects
  • Enterococcus / isolation & purification
  • Gram-Positive Bacterial Infections / prevention & control
  • Humans
  • Incidence
  • Intensive Care Units
  • Kaplan-Meier Estimate
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Proportional Hazards Models
  • Staphylococcal Infections / prevention & control
  • Vancomycin Resistance

Substances

  • Anti-Infective Agents, Local
  • Chlorhexidine

Associated data

  • ClinicalTrials.gov/NCT00502476