Daily bathing with chlorhexidine did not reduce the incidence of healthcare-associated infections among critically ill patients when compared with daily bathing using disposable nonantimicrobial cloths, according to the results of a study published in the January 27, 2015, issue of the Journal of the American Medical Association. The study, which evaluated 9,340 patients who were admitted to five adult intensive care units at a tertiary medical center in Tennessee from July 2012 through July 2013, found that 55 infections occurred during the chlorhexidine bathing period (4 central-line-associated bloodstream infections [CLABSIs], 21 catheter-associated urinary tract infections [CAUTIs], 17 cases of ventilator-associated pneumonia [VAP], and 13 cases of Clostridium difficile) and 60 infections occurred during the control bathing period (4 CLABSIs, 32 CAUTIs, 8 cases of VAP, and 16 cases of C. difficile). The data indicated that the overall incidence rate was 2.86 per 1,000 patient-days during the chlorhexidine bathing periods and 2.90 per 1,000 patient-days during the control bathing periods—a nonsignificant difference according to the researchers. Furthermore, daily bathing with chlorhexidine did not have a significant effect on rates of infection-related secondary outcomes, including hospital-acquired bloodstream infections, blood culture contamination, and clinical cultures yielding multidrug-resistant organisms. The researchers mention that in-hospital mortality appeared to be significantly reduced during chlorhexidine bathing periods in two post hoc analyses; however, they explain that this reduction in in-hospital mortality was no longer present after adjusting for baseline variables.

HRC Recommends: Risk managers should work with the infection prevention and critical care teams to evaluate the applicability of decolonization protocols for their critical care patients. Other measures to prevent infection transmission include consideration of active surveillance testing during outbreaks, contact precautions, hand hygiene, thorough cleaning and disinfection of the environment and equipment, and education of personnel.