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Effectiveness of daily chlorhexidine bathing for reducing gram-negative infections: A meta-analysis

Published online by Cambridge University Press:  26 February 2019

Aditi Patel
Affiliation:
Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
Parth Parikh
Affiliation:
Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
Aaron N. Dunn
Affiliation:
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
Jonathan A. Otter
Affiliation:
National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital, London
Priyaleela Thota
Affiliation:
Hemex Health Incorporation, Portland, Oregon
Thomas G. Fraser
Affiliation:
Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Ohio
Curtis J. Donskey
Affiliation:
Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Abhishek Deshpande
Affiliation:
Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Ohio
Corresponding
E-mail address:

Abstract

Objective:

Multiple studies have demonstrated that daily chlorhexidine gluconate (CHG) bathing is associated with a significant reduction in infections caused by gram-positive pathogens. However, there are limited data on the effectiveness of daily CHG bathing on gram-negative infections. The aim of this study was to determine whether daily CHG bathing is effective in reducing the rate of gram-negative infections in adult intensive care unit (ICU) patients.

Design:

We searched MEDLINE and 3 other databases for original studies comparing daily bathing with and without CHG. Two investigators extracted data independently on baseline characteristics, study design, form and concentration of CHG, incidence, and outcomes related to gram-negative infections. Data were combined using a random-effects model and pooled relative risk ratios (RRs), and 95% confidence intervals (CIs) were derived.

Results:

In total, 15 studies (n = 34,895 patients) met inclusion criteria. Daily CHG bathing was not significantly associated with a lower risk of gram-negative infections compared with controls (RR, 0.89; 95% CI, 0.73–1.08; P = .24). Subgroup analysis demonstrated that daily CHG bathing was not effective for reducing the risk of gram-negative infections caused by Acinetobacter, Escherichia coli, Klebsiella, Enterobacter, or Pseudomonas spp.

Conclusions:

The use of daily CHG bathing was not associated with a lower risk of gram-negative infections. Further, better designed trials with adequate power and with gram-negative infections as the primary end point are needed.

Type
Original Article
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

a

Authors of equal contribution.

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