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Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A
Joshua T Swan1, Carol M Ashton, Lan N Bui
11Department of Pharmacy Practice and Clinical Health Sciences, College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX.2Allied Health Sciences, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, TX.3Department of Pharmacy, Houston Methodist Hospital, Houston, TX.4Center for Outcomes Research, Department of Surgery, Houston Methodist Research Institute, Houston, TX.5Department of Surgery, Houston Methodist Hospital, Houston, TX.6Department of Surgery, Weill Cornell Medical College, New York, NY.7Department of Pharmacy, Memorial Hermann Greater Heights Hospital, Houston, TX.8Surgical Intensive Care Unit, Houston Methodist Hospital, Houston, TX.9Ambulatory Treatment Center, MD Anderson Cancer Center, Houston, TX.10Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston, TX.11Rapides Regional Physician Group, Rapides Regional Medical Center, Alexandria, LA.12Novartis Pharmaceuticals Corporation, East Hanover, NJ.13Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, Houston Methodist Hospital, Houston, TX.14Infection Prevention and Control, Houston Methodist Hospital, Houston, TX.15Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX.
Objective:
To test the hypothesis that compared with daily soap and water bathing, 2% chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients.
Design:
This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded.
Setting:
Twenty-four-bed surgical ICU at a quaternary academic medical center.
Patients:
Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included.
Interventions:
Patients were randomized to bathing with 2% chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm).
Measurements And Main Results:
The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95% CI, 0.309-0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0% (95% CI, 1.5-16.4%; p = 0.019). Incidences of adverse skin occurrences were similar (18.9% soap and water vs 18.6% chlorhexidine; p = 0.95).
Conclusions:
Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.
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