Reassessing Chlorhexidine Bathing

Richard T. Ellison III, MD reviewing Noto MJ et al. JAMA 2015 Jan 20.

A new study challenges the benefits of daily chlorhexidine bathing in reducing hospital-acquired infections.

One recently developed strategy to prevent hospital-acquired infections (HAIs) in intensive care units (ICUs) has been unit-wide patient bathing with chlorhexidine gluconate (CHG) to broadly decrease skin colonization with microbial pathogens. The concept has been supported by several large trials that have suggested potential reductions in rates of hospital-acquired bloodstream infections, central line bloodstream infections, and multidrug-resistant organism (MDRO) acquisition (see, for example, NEJM JW Infect Dis Feb 6 2013). Still, CHG is relatively expensive, and there is concern that ongoing use could lead to the emergence of resistant organisms.

In a recent cluster-randomized, crossover trial conducted between July 2012 and July 2013 in five adult ICUs at a single medical center, researchers compared once-daily bathing with 2% CHG–impregnated cloths and with nonantimicrobial cloths. The primary outcome was a composite of central line–associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections, and Clostridium difficile infections.

Incidence of the primary outcome per 1000 patient-days among 9340 evaluable patients was 2.86 during CHG bathing periods and 2.90 during control bathing periods (P=0.95). In secondary analyses, VAP incidence was higher during CHG bathing periods (0.92 vs. 0.37; P=0.04), but rates of the other individual infections, hospital-acquired bloodstream infections, MDRO acquisition, and in-hospital mortality were similar between periods.

Citation(s):

Noto MJ et al. Chlorhexidine bathing and health care–associated infections: A randomized clinical trial. JAMA 2015 Jan 20.