Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection
Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs).
We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine–impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis.
A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period.
Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired bloodstream infections.
The views expressed in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Dr. Climo reports receiving grant support from Sage Products. Dr. Warren reports receiving consulting fees from Centene, C.R. Bard, Cardinal Health, and Sagentia; lecture fees from 3M Health Care; and grant support through his institution from Cubist Pharmaceuticals and bioMérieux. Dr. Perl reports holding board memberships for Hospira and Pfizer and receiving grant support from Merck. Dr. Weinstein reports serving as an unpaid consultant for Sage Products and receiving grant support from the Foglia Family Foundation. No other potential conflict of interest relevant to this article was reported.