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Effectiveness of Chlorhexidine Bathing to Reduce Catheter-Associated Bloodstream Infections in Medical Intensive Care Unit Patients
Susan C. Bleasdale, MD;
William E. Trick, MD;
Ines M. Gonzalez, MD;
Rosie D. Lyles, MD;
Mary K. Hayden, MD;
Robert A. Weinstein, MD
Arch Intern Med. 2007;167(19):2073-2079.
Objective To determine whether patients bathed daily with chlorhexidine gluconate (CHG) have a lower incidence of primary bloodstream infections (BSIs) compared with patients bathed with soap and water.
Methods The study design was a 52-week, 2-arm, crossover (ie, concurrent control group) clinical trial with intention-to-treat analysis. The study setting was the 22-bed medical intensive care unit (MICU), which comprises 2 geographically separate, similar 11-bed units, of the John H. Stroger Jr (Cook County) Hospital, a 464-bed public teaching hospital in Chicago, Illinois. The study population comprised 836 MICU patients. During the first of 2 study periods (28 weeks), 1 hospital unit was randomly selected to serve as the intervention unit in which patients were bathed daily with 2% CHG-impregnated washcloths (Sage 2% CHG cloths; Sage Products Inc, Cary, Illinois); patients in the concurrent control unit were bathed daily with soap and water. After a 2-week wash-out period at the end of the first period, cleansing methods were crossed over for 24 more weeks. Main outcome measures included incidences of primary BSIs and clinical (culture-negative) sepsis (primary outcomes) and incidences of other infections (secondary outcomes).
Results Patients in the CHG intervention arm were significantly less likely to acquire a primary BSI (4.1 vs 10.4 infections per 1000 patient days; incidence difference, 6.3 [95% confidence interval, 1.2-11.0). The incidences of other infections, including clinical sepsis, were similar between the units. Protection against primary BSI by CHG cleansing was apparent after 5 or more days in the MICU.
Conclusion Daily cleansing of MICU patients with CHG-impregnated cloths is a simple, effective strategy to decrease the rate of primary BSIs.
Trial Registration clinicaltrials.gov Identifier: NCT00130221
Author Affiliations: Departments of Medicine (Infectious Diseases) (Drs Bleasdale, Gonzales, Hayden, and Weinstein), and Pathology (Dr Hayden), Rush University Medical Center, and Department of Medicine (Collaborative Research Unit) (Dr Trick) and Department of Medicine (Infectious Diseases) (Drs Bleasdale, Gonzalez, Lyles, and Weinstein), Cook County Bureau of Health Services, Chicago, Illinois.
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