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Chlorhexidine bathing in a tertiary care neonatal intensive care unit: impact on central line-associated bloodstream
Caroline Quach1, Aaron M Milstone, Chantal Perpête
1Division of Infection Control, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
Chlorhexidine gluconate (CHG) bathing significantly reduced central line-associated bloodstream infections (CLABSIs) in neonates. This intervention proved effective without reported adverse events, offering a valuable strategy for high-CLABSI rate units.
Area of Science:
- Neonatal intensive care
- Infectious disease prevention
- Clinical interventions
Background:
- Central line-associated bloodstream infections (CLABSIs) remain a challenge in neonatal intensive care units (NICUs) despite best practices.
- Investigating novel strategies like chlorhexidine gluconate (CHG) bathing is crucial for reducing healthcare-associated infections in vulnerable neonates.
Purpose of the Study:
- To evaluate the impact of 2% chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates admitted to the NICU.
- To assess the safety and efficacy of CHG bathing as an intervention for reducing CLABSIs in a neonatal population.
Main Methods:
- A quasi-experimental study comparing CLABSI rates before and after implementing CHG bathing in neonates with central venous catheters (CVCs).
- Two groups were analyzed: neonates bathed with mild soap (baseline) and those bathed with 2% CHG-impregnated cloths (intervention).
- Poisson regression was used to calculate adjusted incidence rate ratios (aIRRs) for CLABSIs per 1,000 CVC-days.
Main Results:
- CLABSI rates decreased significantly in neonates bathed with CHG (1.92/1,000 CVC-days) compared to the baseline (6.00/1,000 CVC-days), with an aIRR of 0.33.
- CLABSI rates remained unchanged in neonates not eligible for CHG bathing (8.62/1,000 CVC-days).
- No adverse events were reported during the CHG bathing intervention period.
Conclusions:
- Chlorhexidine gluconate bathing is an effective intervention for reducing CLABSI rates in neonates.
- CHG bathing can be safely implemented in NICUs, even in high-risk populations, when other preventive measures are insufficient.
Background:
Despite implementation of recommended best practices, our central line-associated bloodstream infection (CLABSI) rates remained high. Our objective was to describe the impact of chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates.
Methods:
Infants with a central venous catheter (CVC) admitted to the neonatal intensive care unit from April 2009 to March 2013 were included. Neonates with a birth weight of 1,000 g or less, aged less than 28 days, and those with a birth weight greater than 1,000 g were bathed with mild soap until March 31, 2012 (baseline), and with a 2% CHG-impregnated cloth starting on April 1, 2012 (intervention). Infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with mild soap during the entire period. Neonatal intensive care unit nurses reported adverse events. Adjusted incidence rate ratios (aIRRs), using Poisson regression, were calculated to compare CLABSIs/1,000 CVC-days during the baseline and intervention periods.
Results:
Overall, 790 neonates with CVCs were included in the study. CLABSI rates decreased during the intervention period for CHG-bathed neonates (6.00 vs 1.92/1,000 CVC-days; aIRR, 0.33 [95% confidence interval (CI), 0.15-0.73]) but remained unchanged for neonates with a birth rate of 1,000 g or less and aged less than 28 days who were not eligible for CHG bathing (8.57 vs 8.62/1,000 CVC-days; aIRR, 0.86 [95% CI, 0.17-4.44]). Overall, 195 infants with a birth weight greater than 1,000 g and 24 infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with CHG. There was no reported adverse event.
Conclusions:
We observed a decrease in CLABSI rates in CHG-bathed neonates in the absence of observed adverse events. CHG bathing should be considered if CLABSI rates remain high, despite the implementation of other recommended measures.
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