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Effect of Hospital-Wide Chlorhexidine Patient Bathing on Healthcare-Associated Infections

Published online by Cambridge University Press:  02 January 2015

Mark E. Rupp ,
R. Jennifer Cavalieri ,
Elizabeth Lyden ,
Jennifer Kucera ,
MaryAnn Martin ,
Teresa Fitzgerald ,
Kate Tyner ,
James R. Anderson  and
Trevor C. VanSchooneveld
Mark E. Rupp*
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
R. Jennifer Cavalieri
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Elizabeth Lyden
Affiliation:
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
Jennifer Kucera
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
MaryAnn Martin
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
Teresa Fitzgerald
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
Kate Tyner
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
James R. Anderson
Affiliation:
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
Trevor C. VanSchooneveld
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
*
984031 Nebraska Medical Center, Omaha, NE 68198 (merupp@unmc.edu)
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Abstract

Background.

Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs).

Design.

Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts.

Setting.

Academic medical center.

Patients.

All patients except neonates and infants.

Intervention and Measurements.

CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured.

Results.

Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%, P< .001). A significant decrease in infections due to Clostridium difficile was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57–0.89; P = .003) for 3-days-per-week CHG bathing and 0.41 (95% CI, 0.29–0.59; P < .001) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38–2.53; P =< .001), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported.

Conclusions.

CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 11 , November 2012 , pp. 1094 - 1100
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Klevins, RM, Edwards, JR, Richards, CL, et al.Estimating healthcare-associated infections in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160–166.CrossRefGoogle Scholar
2.Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32(2):101–114.Google Scholar
3.Scott, RD II. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Division of Healthcare Quality Promotion, Centers for Diseases Control and Prevention, http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf. Published March 2009. Accessed September 23, 2011.Google Scholar
4.Milstone, AM, Passaretti, CL, Perl, TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008;46(2):274–281.Google ScholarPubMed
5.Denton, GW. Chlorhexidine. In: Block, SS, ed. Disinfection, Sterilization, and Preservation. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins, 2001:321–336.Google Scholar
6.Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167(19):2073–2079.CrossRefGoogle ScholarPubMed
7.Climo, MW, Sepkowitz, KA, Zuccotti, G, et al.The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009;37(6):1858–1865.CrossRefGoogle ScholarPubMed
8.Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30(10):959–963.CrossRefGoogle ScholarPubMed
9.Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Bloom, DW, Weinstein, RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166(3):306–312.Google Scholar
10.Evans, HL, Dellit, TH, Chan, J, Nathens, AB, Maier, RV, Cuschieri, J. Effect of chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg 2010;145(3):240–246.CrossRefGoogle ScholarPubMed
11.Munoz-Price, LS, Hota, B, Sterner, A, Weinstein, RA. Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital. Infect Control Hosp Epidemiol 2009;30(11):1031–1035.CrossRefGoogle Scholar
12.Kassakian, SZ, Mermel, LA, Jefferson, JA, Parenteau, SL, Machan, JT. Impact of chlorhexidine bathing on hospital-acquired infection among general medical patients. Infect Control Hosp Epidemiol 2011;32(3):238–243.CrossRefGoogle ScholarPubMed
13.Centers for Disease Control and Prevention, National Healthcare Safety Network. NHSN patient safety component manual. http://www.cdc.gov/nhsn/TOC_PSCManual.html. Accessed December 30, 2011.Google Scholar
14.McDonald, LC, Coignard, B, Dubberke, E, et al.Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28(2):140–145.CrossRefGoogle ScholarPubMed
15.Wenzel, RP, Edmond, MB. Infection control: the case for horizontal rather than vertical interventional programs. Int J Infect Dis 2010;14(suppl 4):S3–S5.CrossRefGoogle ScholarPubMed
16.Hibiclens [material safety data sheet]. Wilmington, DE: ICI Americas, 1987.Google Scholar
17.Jury, LA, Guerrero, DM, Burant, CJ, Cadnum, JL, Donskey, CJ. Effectiveness of routine patient bathing to decrease the burden of spores on the skin of patients with Clostridium difficile infection. Infect Control Hosp Epidemiol 2011;32(2):181–184.CrossRefGoogle ScholarPubMed
18.Gilca, R, Hubert, B, Fortin, E, Gaulin, C, Dionne, M. Epidemiological patterns and hospital characteristics associated with increased incidence of Clostridium difficile infection in Quebec, Canada, 1998–2006. Infect Control Hosp Epidemiol 2010;31(9):939–947.CrossRefGoogle ScholarPubMed
19.Dixon, JM, Carver, RL. Daily chlorhexidine gluconate bathing with impregnated cloths results in statistically significant reduction in central line-associated bloodstream infections. Am J Infect Control 2010;38(10):817–821.CrossRefGoogle ScholarPubMed
20.O'Grady, NP, Alexander, M, Burns, LA, et al.Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52(9):1087–1099.CrossRefGoogle ScholarPubMed
21.Batra, R, Cooper, BS, Shiteley, C, Patel, AK, Wyncoll, D, Edgeworth, JD. Efficacy and limitation of a chlorhexidine-based decolonization strategy in preventing transmission of methicillin-resistant Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2010;50(2):210–217.Google Scholar
22.Lee, AS, Macedo-Vinas, M, Francois, P, et al.Impact of combined low-level mupirocin and genotypic chlorhexidine resistance on persistent methicillin-resistant Staphylococcus aureus carriage after decolonization therapy: a case-control study. Clin Infect Dis 2011;52(12):1422–1430.CrossRefGoogle ScholarPubMed
23.Liu, Q, Liu, M, Wu, Q, Li, C, Shou, T, Ni, Y. Sensitivities to biocides and distribution of biocide resistance genes in quaternary ammonium compound tolerant Staphylococcus aureus isolated in a teaching hospital. Scan J Infect Dis 2009;41(6–7):403–409.Google Scholar