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JAMA. 2015 Jan 27;313(4):369-78. doi: 10.1001/jama.2014.18400.

Chlorhexidine bathing and health care-associated infections: a randomized clinical trial.

Author information

1
Department of Medicine, Vanderbilt University, Nashville, Tennessee.
2
Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.

Abstract

IMPORTANCE:

Daily bathing of critically ill patients with the broad-spectrum, topical antimicrobial agent chlorhexidine is widely performed and may reduce health care-associated infections.

OBJECTIVE:

To determine if daily bathing of critically ill patients with chlorhexidine decreases the incidence of health care-associated infections.

DESIGN, SETTING, AND PARTICIPANTS:

A pragmatic cluster randomized, crossover study of 9340 patients admitted to 5 adult intensive care units of a tertiary medical center in Nashville, Tennessee, from July 2012 through July 2013.

INTERVENTIONS:

Units performed once-daily bathing of all patients with disposable cloths impregnated with 2% chlorhexidine or nonantimicrobial cloths as a control. Bathing treatments were performed for a 10-week period followed by a 2-week washout period during which patients were bathed with nonantimicrobial disposable cloths, before crossover to the alternate bathing treatment for 10 weeks. Each unit crossed over between bathing assignments 3 times during the study.

MAIN OUTCOMES AND MEASURES:

The primary prespecified 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. Secondary outcomes included rates of clinical cultures that tested positive for multidrug-resistant organisms, blood culture contamination, health care-associated bloodstream infections, and rates of the primary outcome by ICU.

RESULTS:

During the chlorhexidine bathing period, 55 infections occurred: 4 CLABSI, 21 CAUTI, 17 VAP, and 13 C difficile. During the control bathing period, 60 infections occurred: 4 CLABSI, 32 CAUTI, 8 VAP, and 16 C difficile. The primary outcome rate was 2.86 per 1000 patient-days during the chlorhexidine and 2.90 per 1000 patient-days during the control bathing periods (rate difference, -0.04; 95% CI, -1.10 to 1.01; Pā€‰=ā€‰.95). After adjusting for baseline variables, no difference between groups in the rate of the primary outcome was detected. Chlorhexidine bathing did not change rates of infection-related secondary outcomes including hospital-acquired bloodstream infections, blood culture contamination, or clinical cultures yielding multidrug-resistant organisms. In a prespecified subgroup analysis, no difference in the primary outcome was detected in any individual intensive care unit.

CONCLUSION AND RELEVANCE:

In this pragmatic trial, daily bathing with chlorhexidine did not reduce the incidence of health care-associated infections including CLABSIs, CAUTIs, VAP, or C difficile. These findings do not support daily bathing of critically ill patients with chlorhexidine.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT02033187.

PMID:
25602496
PMCID:
PMC4383133
DOI:
10.1001/jama.2014.18400
[Indexed for MEDLINE]
Free PMC Article
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