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Chlorhexidine Bathing to Reduce Central Venous Catheter-associated Bloodstream Infection: Impact and Sustainability
American Journal of Medicine, 04/09/2012
Clinical Article
Montecalvo MA et al. – In this multiple–hospital study, chlorhexidine bathing was associated with significant reductions in central venous catheter–associated bloodstream infection, and these reductions were sustained post–intervention when chlorhexidine bathing was unmonitored. Chlorhexidine bathing was well tolerated and is a useful adjunct to reduce central venous catheter–associated bloodstream infection.
Methods- In the medical intensive care unit and the respiratory care unit of a tertiary care hospital and the medical–surgical intensive care units of 4 community hospitals, rates of central venous catheter–associated bloodstream infection were collected prospectively for each period.
- Pre–intervention (phase 1) patients were bathed with soap and water or nonmedicated bathing cloths; active intervention (phase 2) patients were bathed with 2% chlorhexidine gluconate cloths with the number of baths administered and skin tolerability assessed; post–intervention (phase 3) chlorhexidine bathing was continued but without oversight by research personnel.
- Central venous catheter–associated bloodstream infection rates were compared over study periods using Poisson regression.
- Compared with pre–intervention, during active intervention there were significantly fewer central venous catheter–associated bloodstream infections (6.4/1000 central venous catheter days vs 2.6/1000 central venous catheter days, relative risk, 0.42; 95% confidence interval, 0.25–0.68; P<.001), and this reduction was sustained during post–intervention (2.9/1000 central venous catheter days; relative risk, 0.46; 95% confidence interval, 0.30–0.70; P<.001).
- During the active intervention period, compliance with chlorhexidine bathing was 82%.
- Few adverse events were observed.