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Daily chlorhexidine bathing in ICU did not reduce HAIs
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Daily chlorhexidine bathing did not reduce incidence of health care–associated infections among patients in ICUs, according to data published in JAMA.
“In the largest study to date, chlorhexidine bathing did not reduce the incidence of multiple health care-associated infections,” Michael J. Noto, MD, PhD, of the department of medicine at Vanderbilt University, told Infectious Disease News. “The results suggest that chlorhexidine bathing is unnecessary which could lead to cost savings as many hospitals are currently bathing patients with chlorhexidine.”
The pragmatic cluster-randomized, crossover, controlled study included 9,340 patients who were admitted to five adult ICUs at one center from July 2012 to July 2013. Patients underwent once-daily bathing with either 2% chlorhexidine cloths or disposable nonantimicrobial cloths. The units used the first assigned cloths for 10 weeks, followed by a 2-week washout period in which all patients were bathed with the nonantimicrobial cloths, then crossed over to the alternate bathing cloth for 10 weeks. The patients crossed between bathing assignment three times. The primary outcome was a composite of central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonia (VAP) and Clostridium difficile infections (CDIs).
There were 55 infections during the chlorhexidine bathing period, including four CLABSIs, 21 CAUTIs, 17 VAPs and 13 CDIs. During the control bathing period, 60 infections occurred: four CLABSIs, 32 CAUTIs, eight VAPs and 16 CDIs. The primary composite outcomes were 2.86 infections per 1,000 patient-days during the chlorhexidine bathing period and 2.9 infections per 1,000 patient-days for the control period. After adjusting for age, sex, race/ethnicity, unit of admission, time, comorbidities and white blood cell count, there was no difference between the groups (adjusted RR=0.94; 95% CI, 0.65-1.37), Noto and colleagues wrote.
There also were no differences in the secondary outcomes, including bloodstream infections, blood culture contamination or multidrug-resistant organisms.
“Health care-associated infections are the most frequent complication of hospital stays and several previous studies have demonstrated that chlorhexidine bathing reduces the rates of some health care-associated infections,” Noto said. “Although we were disappointed that our study did not show a reduction in infections, we are very excited that a large, pragmatic, low-cost, collaborative trial design can be applied to address other questions in critical illness.” – by Emily Shafer
Disclosure: Noto reports no relevant financial disclosures.
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