Daily bathing with 4% chlorhexidine gluconate in intensive care settings: a randomized controlled trial

Pallotto, Carlo; Fiorio, Maurizio; Angelis, Valerio De; Ripoli, Andrea; Franciosini, E.; Girolamo, L Quondam; Volpi, Francesca; Iorio, Paolo; Francisci, Daniela; Tascini, Carlo; Baldelli, Franco

doi:10.1016/j.cmi.2018.09.012

Cited by 41 publications

(45 citation statements)

References 17 publications

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“…In contrast to the findings of the current study, several trials performed in critically ill adults have demonstrated a reduction in BSI with the use of CHG, [11][12][13][14][15][16][17][18] although results have varied among the 4 randomized controlled trials conducted in this population. 11,13,19,20 Two studies demonstrated a benefit of CHG in reducing BSI 13,11 whereas 2 studies did not.…”

Section: Discussioncontrasting

confidence: 99%

Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double‐blinded randomized controlled trial from the Children's Oncology Group

Zerr

Milstone

Dvorak

et al. 2020

Cancer

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BACKGROUND: To the authors' knowledge, information regarding whether daily bathing with chlorhexidine gluconate (CHG) reduces central line-associated bloodstream infection (CLABSI) in pediatric oncology patients and those undergoing hematopoietic stem cell transplantation (HCT) is limited. METHODS: In the current multicenter, randomized, double-blind, placebo-controlled trial, patients aged ≥2 months and <22 years with cancer or those undergoing allogeneic HCT were randomized 1:1 to once-daily bathing with 2% CHG-impregnated cloths or control cloths for 90 days. The primary outcome was CLABSI. Secondary endpoints included total positive blood cultures, acquisition of resistant organisms, and acquisition of cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration. RESULTS: The study was stopped early because of poor accrual. Among the 177 enrolled patients, 174 were considered as evaluable (88 were randomized to the CHG group and 86 were randomized to the control group). The rate of CLABSI per 1000 central line days in the CHG group was 5.44 versus 3.10 in the control group (risk difference, 2.37; 95% confidence interval, 0.05-4.69 [P = .049]). Post hoc conditional power analysis demonstrated a 0.2% chance that the results would have favored CHG had the study fully enrolled. The rate of total positive blood cultures did not differ between groups (risk difference, 2.37; 95% confidence interval, −0.41 to 5.14 [P = .078]). The number of patients demonstrating the new acquisition of resistant organisms did not differ between groups (P = .54). Patients in the CHG group were found to be more likely to acquire cutaneous staphylococcal isolates with an elevated CHG mean inhibitory concentration (P = .032). CONCLUSIONS: The data from the current study do not support the use of routine CHG bathing in children with cancer or those undergoing allogeneic HCT. Cancer 2020;0:1-11.

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Section: Discussioncontrasting

confidence: 99%

Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double‐blinded randomized controlled trial from the Children's Oncology Group

Zerr

Milstone

Dvorak

et al. 2020

Cancer

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“…Afonso et al assumed in their meta-analysis that the decline in CLABSI incidence is due to a reduction in commensal Gram-positive skin micro-organisms, making a contamination of the CVC with these pathogens less likely [18]. In line with this theory, Palotto et al found a significant reduction in Gram-positive micro-organisms among bacteria causing CLABSI after implementation of chlorhexidine bathing [19]. This hypothesis is only partly supported by the current study, because there was (apart from an increase in S. marcescens) no change in the relative frequency of causative pathogens.…”

Section: Discussionmentioning

confidence: 98%

Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections

Scheier

Saleschus

Dunic

et al. 2021

Journal of Hospital Infection

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Background: Daily chlorhexidine bathing has been associated with a reduction in central line-associated bloodstream infections (CLABSI). In the setting of an already established CLABSI surveillance system and an implemented CLABSI prevention bundle, we analysed the effect of daily chlorhexidine bathing in ICU patients on CLABSI incidence and its causative pathogens. Methods: This was a before-and-after study in intensive care units (ICUs) at a tertiary-care centre in Switzerland. Prospective surveillance of CLABSIs and their aetiologies was established. The intervention consisted of daily chlorhexidine bathing of ICU patients with a central venous catheter. A baseline period of 19 months was followed by an intervention period of 9 months. Findings: A total of 5008 patients were included. In the baseline period a mean CLABSI rate of 2.45/1000 catheter days (95% confidence interval (CI) 1.93e3.07) was observed, followed by 1.00/1000 catheter days (95% CI 0.55e1.67; P<0.001) in the intervention period. Introduction of chlorhexidine bathing was independently associated with a reduced risk of CLABSI (adjusted odds ratio 0.47, 95% CI 0.26e0.84, P¼0.011). We did not observe a significant change in aetiology except for an increase of Serratia marcescens in the intervention period. Conclusions: Introduction of daily chlorhexidine bathing resulted in a decline in CLABSI incidence on ICUs. Starting from a baseline CLABSI rate that can be considered standard in a high-income setting and several measures for CLABSI prevention implemented, chlorhexidine bathing proved helpful for a further reduction.

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“…In our hospital, the 2% non‐alcoholic chlorhexidine (whatever its presentation: foam soap such as Aquaseptic or impregnated wash cloths such as Sage products, Cary, Illinois) was not available while the CHG4% was available as foam soap (4% HibiScrub, Mölnlycke Health Care, United Kingdom). In addition, the literature review did not show the superiority of one formulation over the other in 2014, when the cutaneous decontamination protocol was written . Since then, a meta‐analysis published in 2019 seems to show a superiority of CHG4% compared to CHG2% for the prevention of HAIs …”

Section: Discussionmentioning

confidence: 99%

“…In addition, the literature review did not show the superiority of one formulation over the other in 2014, when the cutaneous decontamination protocol was written. 13,14 Since then, a meta-analysis published in 2019 seems to show a superiority of CHG4% compared to CHG2% for the prevention of HAIs. 15 The incidence rate of CLABSI observed before and after implementation of our targeted protocol is comparable to rates seen in other PICU studies.…”

Section: Discussionmentioning

confidence: 99%

Central‐line‐associated bloodstream infections in a surgical paediatric intensive care unit: Risk factors and prevention with chlorhexidine bathing

Martinez

Baugnon

Vergnaud

et al. 2020

J Paediatrics Child Health

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Aim The aims of the study are to evaluate the impact of a 4% chlorhexidine (CHG4%) bathing on the occurrence of central‐line‐associated bloodstream infection (CLABSI) and to identify risk factors (RFs) for CLABSI in our population. This is a retrospective monocentric cohort study in the paediatric surgical intensive care unit at the Necker Enfants Malades Hospital, Paris, France. Methods All hospitalised patients with central venous catheters (CVCs) in 2015 were included. CHG4% bathing was prescribed in CLABSI high‐risk patients, defined by the presence of exposition factors (EFs): constitutive or acquired immunosuppression, presence of an invasive medical device (IMD) and the carriage of Staphylococcus aureus. The overall 2015 CLABSI incidence rate was compared with 2014 CLABSI incidence rate (before CHG4% bathing). Results In all, 775 patients were analysed. Some 182 had at least one EF, and 49 received CHG4%. The incidence rates of CLABSI in 2014 and 2015 were, respectively, 6.1 and 2.3/1000 days CVC (P < 0.01). The presence of at least one EF was associated with the CLABSI's occurrence: odds ratio = 15.13 (95% confidence interval: 4.26–53.71; P < 0.0001), particularly acquired immunosuppression, IMD and S. aureus colonisation. Other RFs were age <1 year and carrying duration >16 days. Conclusions This study showed a significant reduction in incidence of CLABSI after introduction of a targeted CHG4% bathing protocol. Presence of IMD, S. aureus colonisation, immunosuppression, age <1 year and carrying duration >16 days were CLABSI RFs. Regarding the literature, the presence of IMD seems to be underestimated in CLABSI prevention.

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Daily bathing with 4% chlorhexidine gluconate in intensive care settings: a randomized controlled trial

Cited by 41 publications

References 17 publications

Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double‐blinded randomized controlled trial from the Children's Oncology Group

Chlorhexidine gluconate bathing in children with cancer or those undergoing hematopoietic stem cell transplantation: A double‐blinded randomized controlled trial from the Children's Oncology Group

Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections

Central‐line‐associated bloodstream infections in a surgical paediatric intensive care unit: Risk factors and prevention with chlorhexidine bathing

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