Prospective, crossover, comparative study of two methods of chlorhexidine bathing

Area of Science:

• Infection control in intensive care units (ICUs)
• Antimicrobial efficacy of chlorhexidine gluconate (CHG)
• Healthcare-associated infection (HAI) prevention strategies

Background:

• Chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients is established to decrease healthcare-associated infections (HAIs).
• The optimal method for CHG bathing in ICUs has not been definitively determined.
• This study addresses the need for evidence-based guidelines on CHG bathing protocols.

Purpose of the Study:

• To compare the efficacy of 2% CHG-impregnated cloths versus 4% CHG solution for daily patient bathing in ICUs.
• To evaluate the impact of different CHG bathing methods on skin microbial colonization and CHG skin concentration.
• To assess healthcare-associated infections (HAIs), adverse reactions, and skin tolerability associated with each CHG bathing method.

Main Methods:

• A prospective crossover study design was employed, involving two ICUs.
• Units alternated between using 2% CHG cloths and 4% CHG solution for daily patient bathing in two phases.
• Skin swabs were collected to quantify microbial colonization and CHG concentration, alongside monitoring for HAIs and adverse events.

Main Results:

• Both 2% CHG cloths and 4% CHG solution significantly reduced microbial skin colonization compared to no CHG bath (P < .001).
• The 2% CHG cloths resulted in significantly lower microbial colonization (691 CFU/cm²) and higher CHG skin concentration (1300.4 ppm) compared to the 4% CHG solution (1627 CFU/cm² and 307.2 ppm).
• Both bathing methods were well-tolerated, with no significant difference in HAI rates observed between the groups.

Conclusions:

• Daily bathing with either 2% CHG cloths or 4% CHG solution effectively decreases microbial skin colonization in ICU patients.
• The 2% CHG cloths demonstrated superior performance, achieving greater CHG skin concentration and a more significant reduction in microbial load.
• These findings support the use of 2% CHG cloths as an effective method for CHG bathing in ICUs to reduce microbial colonization.