Hostname: page-component-7b9c58cd5d-dlb68 Total loading time: 0 Render date: 2025-03-15T07:21:16.009Z Has data issue: false hasContentIssue false
  • English
  • Français

The Efficacy of Daily Bathing with Chlorhexidine for Reducing Healthcare-Associated Bloodstream Infections: A Meta-analysis

Published online by Cambridge University Press:  02 January 2015

John C. O'Horo ,
Germana L. M. Silva ,
L. Silvia Munoz-Price  and
Nasia Safdar
John C. O'Horo
Affiliation:
Department of Graduate Medical Education, Aurora Healthcare Metro, Milwaukee, Wisconsin
Germana L. M. Silva
Affiliation:
Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin
L. Silvia Munoz-Price
Affiliation:
Departments of Medicine and of Public Health and Epidemiology, Miller School of Medicine, University of Miami, Miami, Florida
Nasia Safdar*
Affiliation:
Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin
*
University of Wisconsin Medical School, 1685 Highland Avenue, Madison, WI 53705 (ns2@medicine.wisc.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Design.

Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies to assess the efficacy of daily bathing with chlorhexidine (CHG) for prevention of healthcare-associated bloodstream infections (BSIs).

Setting.

Medical, surgical, trauma, and combined medical-surgical intensive care units (ICUs) and long-term acute care hospitals.

Participants.

Inpatients.

Methods.

Data on patient population, diagnostic criteria for BSIs, form and concentration of topical CHG, incidence of BSIs, and study design were extracted.

Results.

One randomized controlled trial and 11 nonrandomized controlled trials reporting a total of 137,392 patient-days met the inclusion criteria; 291 patients in the CHG arm developed a BSI over 67,775 patient-days, compared with 557 patients in the control arm over 69,617 catheter-days. CHG bathing resulted in a reduced incidence of BSIs: the pooled odds ratio using a random-effects model was 0.44 (95% confidence interval, 0.33–0.59; P< .00001). Statistical heterogeneity was moderate, with an I2 of 58%. For the subgroup of studies that examined central line–associated BSIs, the odds ratio was 0.40 (95% confidence interval, 0.27–0.59).

Conclusions.

Daily bathing with CHG reduced the incidence of BSIs, including central line-associated BSIs, among patients in the medical ICU. Further studies are recommended to determine the optimal frequency, method of application, and concentration of CHG as well as the comparative effectiveness of this strategy relative to other preventive measures available for reducing BSIs. Future studies should also examine the efficacy of daily CHG bathing in non-ICU populations at risk for BSI.

Infect Control Hosp Epidemiol 2012;33(3):257-267

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 3 , March 2012 , pp. 257 - 267
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control and Prevention. Vital signs: central line-associated blood stream infections—United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60(8):243–248.Google Scholar
2. Safdar, N, Maki, DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004;30(1):62–67.Google Scholar
3. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2002;30(8):476–489.CrossRefGoogle ScholarPubMed
4. Garland, JS, Buck, RK, Maloney, P, et al. Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial. Pediatr Infect Dis J 1995;14(6):510–516.Google Scholar
5. Maki, DG, Ringer, M, Alvarado, CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338(8763):339–343.Google Scholar
6. Chaiyakunapruk, N, Veenstra, DL, Lipsky, BA, Saint, S. Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 2002;136(11):792–801.CrossRefGoogle ScholarPubMed
7. Timsit, JF, Schwebel, C, Bouadma, L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 2009;301(12):1231–1241.Google Scholar
8. Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009;37(6):1858–1865.Google Scholar
9. Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167(19):2073–2079.CrossRefGoogle ScholarPubMed
10. Lio, PA, Kaye, ET. Topical antibacterial agents. Infect Dis Clin North Am 2004;18(3):717–733.CrossRefGoogle ScholarPubMed
11. Camus, C, Bellissant, E, Sebille, V, et al. Prevention of acquired infections in intubated patients with the combination of two decontamination regimens. Crit Care Med 2005;33(2):307–314.Google Scholar
12. Borer, A, Gilad, J, Porat, N, et al. Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit. J Hosp Infect 2007;67(2):149–155.Google Scholar
13. Gould, IM, MacKenzie, FM, MacLennan, G, Pacitti, D, Watson, EJ, Noble, DW. Topical antimicrobials in combination with admission screening and barrier precautions to control endemic methicillin-resistant Staphylococcus aureus in an intensive care unit. Int J Antimicrob Agents 2007;29(5):536–543.Google Scholar
14. Holder, C, Zellinger, M. Daily bathing with chorhexidine in the ICU to prevent central line-associated bloodstream infections. J Clin Outcomes Manag 2009;16(11):509–513.Google Scholar
15. Munoz-Price, LS, Hota, B, Sterner, A, Weinstein, RA. Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital. Infect Control Hosp Epidemiol 2009;30(11):1031–1035.CrossRefGoogle Scholar
16. Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30(10):959–963.Google Scholar
17. Evans, HL, Dellit, TH, Chan, J, Nathens, AB, Maier, RV, Cuschieri, J. Effect of chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg 2010;145(3):240–246.Google Scholar
18. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 2009;62(10):1006–1012.CrossRefGoogle ScholarPubMed
19. Higgins, JP, Green, S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Oxford: Cochrane Collaboration, 2008.Google Scholar
20. Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557–560.Google Scholar
21. Fraser, TG, Fatica, C, Scarpelli, M, et al. Decrease in Staphylococcus aureus colonization and hospital-acquired infection in a medical intensive care unit after institution of an active surveillance and decolonization program. Infect Control Hosp Epidemiol 2010;31(8):779–783.CrossRefGoogle Scholar
22. Dixon, JM, Carver, RL. Daily chlorohexidine gluconate bathing with impregnated cloths results in statistically significant reduction in central line-associated bloodstream infections. Am J Infect Control 2010;38(10):817–821.Google Scholar
23. Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Daily skin cleansing with chlorhexidine did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit. Intensive Care Med 2010;36(5):854–858.CrossRefGoogle ScholarPubMed
24. Montecalvo, MA, McKenna, D, Lynda, M, et al. Chlorhexidine (CHG) bathing reduces healthcare-associated bloodstream infection (HA-BSI) and blood culture contaminants (BC-contam): a multiple hospital study of ICU and respiratory care patients (pts). Paper presented at: SHEA 5th Decennial International Conference on Healthcare-Associated Infections; March 18–22, 2010; Atlanta.Google Scholar
25. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16(3):128–140.Google Scholar
26. Lin, MY, Hota, B, Khan, YM, et al. Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates. JAMA 2010;304(18):2035–2041.Google Scholar
27. Climo, M, Diekema, D, Warren, DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24(12):942–945.Google Scholar
28. O'Grady, NP, Alexander, M, Dellinger, EP, et al; Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002;51(RR-10):1–29.Google Scholar