Published in JAMA 2015 Jan 20
Authors: Noto MJ et al.
A new study challenges the benefits of daily chlorhexidine bathing in reducing hospital-acquired infections.
One recently developed strategy to prevent hospital-acquired infections (HAIs) in intensive care units (ICUs) has been unit-wide patient bathing with chlorhexidine gluconate (CHG) to broadly decrease skin colonization with microbial pathogens. The concept has been supported by several large trials that have suggested potential reductions in rates of hospital-acquired bloodstream infections, central line bloodstream infections, and multidrug-resistant organism (MDRO) acquisition (see, for example, NEJM JW Infect Dis Feb 6 2013). Still, CHG is relatively expensive, and there is concern that ongoing use could lead to the emergence of resistant organisms.
In a recent cluster-randomized, crossover trial conducted between July 2012 and July 2013 in five adult ICUs at a single medical center, researchers compared once-daily bathing with 2% CHG–impregnated cloths and with nonantimicrobial cloths. The primary outcome was a composite of central line–associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections, and Clostridium difficile infections.
Incidence of the primary outcome per 1000 patient-days among 9340 evaluable patients was 2.86 during CHG bathing periods and 2.90 during control bathing periods (P=0.95). In secondary analyses, VAP incidence was higher during CHG bathing periods (0.92 vs. 0.37; P=0.04), but rates of the other individual infections, hospital-acquired bloodstream infections, MDRO acquisition, and in-hospital mortality were similar between periods.
Comment
Although the initial rationale for CHG bathing in ICUs was preventing MDRO transmission, this effect was not incorporated into the primary study outcome, nor was active surveillance performed to assess it. In addition, the total number of CLABSIs during this trial (8) was lower than that in other recent trials, suggesting that the bacteremia rate had already been reduced to a level at which the study was underpowered to detect an effect. The findings suggest that institutions should evaluate the potential benefits of CHG bathing in the context of their overall infection-prevention programs and their MDRO-acquisition and HAI rates.