Daily bathing with chlorhexidine gluconate reduces CLABSI rates in NICUs

When used in conjunction with a bundled central venous line, chlorhexidine gluconate bathing considerably reduced central line associated bloodstream infections in neonatal intensive care units.

“The use of chlorhexidine gluconate – CHG – for daily bathing of hospitalized patients is one of many evidence-based practices utilized in attempt to prevent [central line associated bloodstream infections (CLABSI)] and other health care-associated infections,” researcher Andrea Green Hines, MD, from the Division of Pediatric Infectious Diseases at the University of Nebraska Medical Center, told Infectious Diseases in Children. “Although CHG is not currently approved by the FDA for use in children less than 2 months of age due to a lack of safety and efficacy in this population, off-label use of CHG in NICUs is common.”

CHG is frequently used as a topical antiseptic off-label due to its ability to decrease CLABSI. In this study, researchers wanted to observe the change in NICU CLABSI rates in 2015 and 2016, as well as to monitor the skin condition of bathed infants and nursing compliance, CHG knowledge and importance ranking of CHG bathing pre- and post-study.

Infants who were considered for CHG bathing were in a NICU with central venous lines, though any infant born at less than 28 weeks estimated gestational age were not included until they had more than 14 days of life. Infants who had a skin breakdown score of greater than or equal to seven on the Neonatal Skin Condition Score (NSCS) were also excluded.

Infants eligible for CHG bathing received baths with 2% CHG wipes three times weekly. Nurses were responsible for charting a NCSC score twice daily, and researchers computed the annual NICU CLABSI rate in accordance to the National Healthcare Safety Network definition.

The researchers observed a decrease in CLABSI rates from 2015 (3.55 per 1,000 device days) to 2016 (0.24 per 1,000 device days), while noting an increase in nurse compliance from 86% to 95%. Less than 1% of infants were required to discontinue CHG bathing due to a NCSC score of greater than or equal to seven.

Additionally, nursing staff surveys revealed a high level of knowledge (92% identified) regarding topical antiseptic activity of CHG. The researchers noted that potential skin breakdown and negative side effects were most frequently listed as a concern at 83.1%. At the beginning of the study, 52% of nurses felt that CHG bathing was moderately to extremely important which increased to 88% of nurses by the end of the study; parental refusal was the only barrier identified by nurses.

“We believe that the increase in nursing knowledge and importance ranking led to increased CHG bathing compliance which in turn contributed to the reduction of CLABSIs in the NICU,” Green Hines told Infectious Diseases in Children.

Reference:

Green Hines A, et al. Abstract 9189. Presented at: The Society for Healthcare Epidemiology of America (SHEA) spring conference; March 29-31, 2017; St. Louis, MO.

Disclosure: The researchers report no relevant financial disclosures.