Findings do not support chlorhexidine bathing in ICUs
Once daily bathing with disposable cloths with the topical antimicrobial agent chlorhexidine of critically ill patients did not reduce the incidence of health care-associated infections.
Infections acquired during hospitalization (health care associated infections) are associated with increased hospital length of stay, rates of death, and increased costs. The skin of hospitalized patients is a reservoir for infectious pathogens. Subsequent invasion by skin flora is thought to be a mechanism contributing to health care-associated infections. Chlorhexidine is a broad-spectrum topical antimicrobial agent that, when used to bathe the skin, may decrease the bacterial burden, thereby reducing infections. Chlorhexidine bathing is incorporated into some expert guidelines, according to background information in the article.
Michael J. Noto, M.D., Ph.D., of Vanderbilt University, Nashville, Tenn., and colleagues conducted a study in which five adult intensive care units in Nashville performed once-daily bathing of all patients (n = 9,340) with disposable cloths impregnated with 2 percent chlorhexidine or non-antimicrobial cloths as a control. Bathing treatments were performed for a 10-week period followed by a 2-week washout period (a period allowed in order to eliminate the effect of the first intervention before starting a new intervention), during which patients were bathed with non-antimicrobial disposable cloths, before switching to the alternate bathing treatment for another 10 weeks.
A total of 55 infections occurred during the chlorhexidine bathing period (4 central line-associated bloodstream infections [CLABSIs], 21 catheter-associated urinary tract infections [CAUTIs], 17 ventilator-associated pneumonia [VAP], and 13 Clostridium difficile) and 60 infections during the control bathing periods (4 CLABSI, 32 CAUTI, 8 VAP, and 16 C difficile infections). After adjusting for various factors, no significant difference between groups in the rate of the primary outcome (composite of these infections) was detected.
Other infection-related secondary outcomes, including health care-associated bloodstream infections, blood culture contamination, and clinical cultures positive for multi-drug resistant organisms were also not improved by chlorhexidine.