Effect of daily chlorhexidine bathing on reducing infections caused by multidrug‐resistant organisms in intensive care unit patients: A semiexperimental study with parallel controls

Abstract

Background: A number of studies have shown that daily bathing by chlorhexidine (CHG) wipes in ICU can reduce healthcare-associated infections (HAIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE). However, the impact of CHG bathing on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Enterobacteriaceae (CRE) is not clear and remains controversial.Methods: A semi-experimental study which employs both pre-controls and a parallel control was conducted. In the intervention period (from July 1 to December 31, 2016), strengthened infection control measures and daily bathing with 2% CHG-impregnated wipes once daily was performed in the ICU. Fiftyseven non-ICU wards with the occurrence of multidrug-resistant organisms (MDRO) infections during the same time period were selected as parallel control group (only CHG bathing was not performed). The net effect of the 2% CHG daily bathing was evaluated by the difference in difference (DID) model.Results: The incidence of HAIs caused by CRPA in ICU was signi cantly decreased between the intervention and pre-intervention period (2.5, 95% con dence interval (CI) 1. cases /1,000 patient days, P = 0.02). Similarly, the incidence of HAIs caused by CRAB in intervention group was 19.75% lower than that in pre-intervention group (6.0, 95% CI 4.4-7.6 vs. 7.5, 95% CI 5.7-9.3 cases / 1,000 patient days, P = 0.24). The DID model analysis showed that CHG bathing reduced the incidence of CRAB-and CRPA-caused infections in ICU by 1.56 and 2.15 cases/1,000 patient days, respectively, P <0.01, and bathing of every 38 patients (95% CI, 21-268) and 39 patients (95% CI, 24-110) were able to prevent one case of HAIs of CRAB and CRPA, respectively. However, CHG bathing showed no effect on MRSA, VRE and CRE (P>0.05).Conclusion: Daily bathing with 2% CHG-impregnated wipes can reduce HAIs caused by CRAB and CRPA, while it is not effective for the prevalence of infections caused by MRSA, VRE, and CRE.

Horizontal versus vertical strategies for infection prevention: current practices and controversies

“…Similarly, a systematic review with meta-analysis revealed that CHG reduced the risk of CLABSI by 48% compared to conventional patient bathing [risk ratio (RR) 0.52; 95% confidence interval (95% CI) 0.37–0.73] [33 ▪▪ ]. In a recent before-and-after study examining the effect of chlorhexidine bathing on MDRO HAIs, Huang et al [34] found that CHG bathing lowered the incidence of carbapenem-resistant Pseudomonas aeruginosa from 4.6 to 2.5 per 1000 patient days ( P = 0.02). However, this had no effect on the incidence of MRSA, VRE, CRE, and CRAB infections ( P > 0.05) [34].…”

“…In a recent before-and-after study examining the effect of chlorhexidine bathing on MDRO HAIs, Huang et al [34] found that CHG bathing lowered the incidence of carbapenem-resistant Pseudomonas aeruginosa from 4.6 to 2.5 per 1000 patient days ( P = 0.02). However, this had no effect on the incidence of MRSA, VRE, CRE, and CRAB infections ( P > 0.05) [34]. On the contrary, an interrupted time series analysis did not reveal a decline in MDRO acquisition, including MRSA, VRE, and resistant Gram-negative infections among ICU patients bathed daily with CHG [35].…”

“…]. In a recent before-and-after study examining the effect of chlorhexidine bathing on MDRO HAIs, Huang et al [34] found that CHG bathing lowered the incidence of carbapenem-resistant Pseudomonas aeruginosa from 4.6 to 2.5 per 1000 patient days (P ¼ 0.02). However, this had no effect on the incidence of MRSA, VRE, CRE, and CRAB infections (P > 0.05) [34].…”