Chlorhexidine bathing significantly reduces the development of hospital-acquired blood-stream infections

Feb 6th – NEJM – Daily bathing with a chlorhexidine-impregnated washcloth was associated with a 28% lower rate of bloodstream infections. 

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1. Daily bathing with a chlorhexidine-impregnated washcloth was associated with a 28% lower rate of bloodstream infections when compared with daily washing with a nonantimicrobial washcloth.

2. Chlorhexidine bathing was also associated with a 25% reduction in acquisition of multidrug-resistant organisms.

This randomized study examined the effect of chlorhexidine washes on incidence of infection and development of multidrug-resistant organisms in ICUs and bone marrow transplant units.  The authors found that replacing standard daily washes with washes using a chlorhexidine-impregnated washcloth significantly lowered the incidence of blood-stream infections and the acquisition of the drug resistant organisms MRSA and VRE.  Of note, during the study the company providing the chlorhexidine washcloths temporarily recalled them due to a Burkholderia cepacia contamination of some of the lots.  Patients were immediately switched to the nonantimicrobial washcloths, and data from the centers were omitted from analysis of the chlorhexidine treatment.  Additionally, two units were eliminated from the analysis due to low compliance with the study protocol.  Overall, the results suggest that a low-cost, straightforward intervention could significantly lower the incidence of hospital-acquired infections and acquisition of drug-resistant organisms.

Click to read the study in NEJM

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1. Daily bathing with a chlorhexidine-impregnated washcloth was associated with a 28% lower rate of bloodstream infections when compared with daily washing with a nonantimicrobial washcloth.

2. Chlorhexidine bathing was also associated with a 25% reduction in acquisition of multidrug-resistant organisms.

This [cluster-randomized crossover] study: collected data from multiple centers between 2007 and 2009.  Units were assigned to bathe patients daily using either washcloths with 2% chlorhexidine gluconate or a nonantimicrobial washcloth for six months.  The centers then would switch and use the alternative product for a second six month period.  Patients were then monitored for MRSA and VRE colonization as well as blood stream infections.  165 new cases of MRSA or VRE developed during control periods, while only 127 developed during the chlorhexidine wash periods, yielding a 28% lower rate.  However, there was no significant difference in the rates of MRSA or VRE bacteremia.  Additionally ICUs showed a 40% lower rate of bloodstream infections with chlorhexidine bathing.  Other units showed a 17% lower rate.  There were no skin reactions attributed to chlorhexidine.

In sum: This randomized study examined the effect of chlorhexidine washes on incidence of infection and development of multidrug-resistant organisms in ICUs and bone marrow transplant units.  The authors found that replacing standard daily washes with washes using a chlorhexidine-impregnated washcloth significantly lowered the incidence of blood-stream infections and the acquisition of the drug resistant organisms MRSA and VRE.  Of note, during the study the company providing the chlorhexidine washcloths temporarily recalled them due to a Burkholderia cepacia contamination of some of the lots.  Patients were immediately switched to the nonantimicrobial washcloths, and data from the centers were omitted from analysis of the chlorhexidine treatment.  Additionally, two units were eliminated from the analysis due to low compliance with the study protocol.  Overall, the results suggest that a low-cost, straightforward intervention could significantly lower the incidence of hospital-acquired infections and acquisition of drug-resistant organisms.

Click to read the study in NEJM

By Akira Shishido and Mitalee Patil

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