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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*

Climo, Michael W. MD; Sepkowitz, Kent A. MD; Zuccotti, Gianna MD, MPH; Fraser, Victoria J. MD; Warren, David K. MD; Perl, Trish M. MD, MSc; Speck, Kathleen; Jernigan, John A. MD; Robles, Jaime R. PhD; Wong, Edward S. MD

doi: 10.1097/CCM.0b013e31819ffe6d
Continuing Medical Education Article

Objective: Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patients.

Design, Setting, and Patients: Six ICUs at four academic centers measured the incidence of MRSA and VRE colonization and BSI during a period of bathing with routine soap for 6 months and then compared results with a 6-month period where all admitted patients received daily bathing with a chlorhexidine solution. Changes in incidence were evaluated by Poisson and segmented regression modeling.

Interventions: Daily bathing with a chlorhexidine-containing solution.

Measurements and Main Results: Acquisition of MRSA decreased 32% (5.04 vs. 3.44 cases/1000 patient days, p = 0.046) and acquisition of VREdecreased 50% (4.35 vs. 2.19 cases/1000 patient days, p = 0.008) following the introduction of daily chlorhexidine bathing. Segmented regression analysis demonstrated significant reductions in VRE bacteremia (p = 0.02) following the introduction of chlorhexidine bathing. VRE-colonized patients bathed with chlorhexidine had a lower risk of developing VRE bacteremia (relative risk 3.35; 95% confidence interval 1.13–9.87; p = 0.035), suggesting that reductions in the level of colonization led to the observed reductions in BSI.

Conclusion: We conclude that daily chlorhexidine bathing among ICU patients may reduce the acquisition of MRSA and VRE. The approach is simple to implement and inexpensive and may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated BSI.

Hospital Epidemiologist (MWC), Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA; Vice Chair (KAS), Clinical Affairs Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; Director (KAS), Infection Control, Memorial Sloan-Kettering Cancer Center, New York, NY; Senior Medical Informatician (GZ), Patient Safety-Risk Management, Brigham and Women’s Hospital, Welksley, MA; Professor of Medicine (VJF), Washington University School of Medicine, St. Louis, MO; Co-Director (VJF), Infectious Diseases, Washington University School of Medicine, St. Louis, MO; Assistant Professor of Medicine (DKW), Washington University School of Medicine, St. Louis, MO; Professor of Medicine (TMP), Pathology and Epidemiology, Johns Hopkins University, Baltimore, MD; Hospital Epidemiologist (TMP), Johns Hopkins Hospital, Baltimore, MD; Research Program Manager (KS), Johns Hopkins University School of Medicine, Baltimore, MD; Deputy Chief (JAJ), Prevention and Response Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Associate Professor (JRR), Virginia Commonwealth University, Richmond, VA; Professor of Medicine (ESW), Virginia Commonwealth University, Richmond, VA; and Chief (ESW), Infectious Disease, McGuire Veterans Affairs Hospital, Richmond, VA.

This work was supported by a cooperative program award from the Centers for Disease Control and Prevention.

For information regarding this article, E-mail: edward.wong@va.gov

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins