Clinical question

In patients at high risk, does daily bathing with chlorhexidine-impregnated washcloths reduce the risk of hospital-acquired bloodstream infections?

Bottom line

For hospitalized patients at high-risk of nosocomial infections, daily bathing with chlorhexidine-impregnated washcloths reduces the rate of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) acquisition, but was not found to reduce the rate of bloodstream infections from these organisms. The rate of hospital-acquired bloodstream infections overall was significantly reduced; this included infections from other organisms such as coagulase-negative staphylococci (CoNS) and fungi. LOE = 1b

Reference

Climo MW, Yokoe DS, Warren DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368(6):533-542.

Study design

Randomized controlled trial (nonblinded)

Funding source

Industry + government

Allocation

Uncertain

Setting

Inpatient (any location)

Synopsis

In this multicenter trial, investigators enrolled patients in 8 intensive care units and one bone marrow transplantation unit. Each unit was randomized to bathe patients daily with either nonantimicrobial washcloths or 2% chlorhexidine-impregnated washcloths for 6 months, followed by the alternate product for the next 6 months. Bathing was performed by using the washcloths on all body surfaces sequentially, excluding the face, per manufacturer’s instructions. Active surveillance testing for MRSA and VRE was performed on all units during the study period. Analysis was by intention to treat. Use of chlorhexidine washcloths lowered the risk of MRSA or VRE acquisition by 23% (5.10 vs 6.60 cases per 1000 patient-days; P = .03). The rate of hospital-acquired bloodstream infections also decreased by 28% with the use of these washcloths (3.78 vs 6.60 cases per 1000 patient-days; P = .007). Specifically, both primary bloodstream infections and central catheter-associated bloodstream infections occurred less frequently with the intervention (31% decrease in primary infections, P = .006; 53% decrease in catheter-related infections, P = .004). Thirty percent of the 221 bloodstream infections detected during both the intervention and control periods were due to staphylococci, either Staphylcoccus aureus or CoNS. Use of the chlorhexidine washcloths decreased CoNS bloodstream infections by 56% (0.60 vs 1.36 cases per 1000 patient-days; P = .008) and fungal central catheter-associated infections by 90% (0.07 vs 0.77 cases per 1000 catheter-days; P < .001). There were no serious adverse events associated with the chlorhexidine washcloths. The MRSA and VRE isolates that were acquired did not show increased resistance to chlorhexidine although this does not allay the concern regarding longer-term emergence of high-level resistance.