Related Experiment Video
Updated: May 14, 2026
A Method to Test the Efficacy of Handwashing for the Removal of Emerging Infectious Pathogens
Published on: June 7, 2017
Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised,
Aaron M Milstone1, Alexis Elward, Xiaoyan Song
1Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. amilsto1@jhmi.edu
Insights
Daily chlorhexidine gluconate (CHG) bathing reduced bloodstream infections (bacteraemia) in critically ill children. This well-tolerated intervention offers a promising strategy for improving patient outcomes in pediatric intensive care units.
Area of Science:
- Infectious Disease Epidemiology
- Pediatric Critical Care Medicine
- Antimicrobial Stewardship
Background:
- Bacteraemia poses a significant threat to critically ill children, contributing to substantial morbidity and mortality.
- Standard bathing practices may not adequately prevent bloodstream infections in this vulnerable population.
Purpose of the Study:
- To evaluate the efficacy of daily chlorhexidine gluconate (CHG) bathing in reducing the incidence of bacteraemia among critically ill children.
- To compare CHG bathing with standard bathing protocols in pediatric intensive care units.
Main Methods:
- A cluster-randomised, two-period crossover trial involving ten paediatric intensive-care units across five hospitals.
- Patients over two months old received either 2% CHG-impregnated cloths or standard bathing for six-month periods, with units switching protocols mid-study.
- Intention-to-treat (ITT) and per-protocol (PP) analyses were conducted on 4947 eligible admissions.
Main Results:
- The per-protocol analysis showed a statistically significant reduction in bacteraemia incidence with CHG bathing (3.28 per 1000 days) compared to standard care (4.93 per 1000 days).
- The intention-to-treat analysis indicated a non-significant trend towards reduced bacteraemia with CHG bathing (3.52 vs. 4.93 per 1000 days).
- CHG bathing was well-tolerated, with a low incidence of skin reactions (1.2 per 1000 days).
Conclusions:
- Daily CHG bathing is an effective and safe method for decreasing bacteraemia incidence in critically ill children.
- This intervention represents a valuable addition to infection control strategies in pediatric intensive care settings.
Background:
Bacteraemia is an important cause of morbidity and mortality in critically ill children. Our objective was to assess whether daily bathing in chlorhexidine gluconate (CHG) compared with standard bathing practices would reduce bacteraemia in critically ill children.
Methods:
In an unmasked, cluster-randomised, two-period crossover trial, ten paediatric intensive-care units at five hospitals in the USA were randomly assigned a daily bathing routine for admitted patients older than 2 months, either standard bathing practices or using a cloth impregnated with 2% CHG, for a 6-month period. Units switched to the alternative bathing method for a second 6-month period. 6482 admissions were screened for eligibility. The primary outcome was an episode of bacteraemia. We did intention-to-treat (ITT) and per-protocol (PP) analyses. This study is registered with ClinicalTrials.gov (identifier NCT00549393).
Findings:
1521 admitted patients were excluded because their length of stay was less than 2 days, and 14 refused to participate. 4947 admissions were eligible for analysis. In the ITT population, a non-significant reduction in incidence of bacteraemia was noted with CHG bathing (3·52 per 1000 days, 95% CI 2·64-4·61) compared with standard practices (4·93 per 1000 days, 3·91-6·15; adjusted incidence rate ratio [aIRR] 0·71, 95% CI 0·42-1·20). In the PP population, incidence of bacteraemia was lower in patients receiving CHG bathing (3·28 per 1000 days, 2·27-4·58) compared with standard practices (4·93 per 1000 days, 3·91-6·15; aIRR 0·64, 0·42-0·98). No serious study-related adverse events were recorded, and the incidence of CHG-associated skin reactions was 1·2 per 1000 days (95% CI 0·60-2·02).
Interpretation:
Critically ill children receiving daily CHG bathing had a lower incidence of bacteraemia compared with those receiving a standard bathing routine. Furthermore, the treatment was well tolerated.
Funding:
Sage Products, US National Institutes of Health.
Related Concept Videos
01:23Hand hygiene
Hand washing...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:30Cleaning, Sterilization, and Disinfection
Cleaning
The cleaning process usually involves using water with detergents or enzymatic cleaner and removing foreign material from objects and surfaces, including organic material such as body fluids or inorganic material like soil. Cleaning is performed before high-level disinfection and sterilization because foreign materials on the cover of the devices interfere with process...