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Effect of Hospital-Wide Chlorhexidine Patient Bathing on Healthcare-Associated Infections

Published online by Cambridge University Press:  02 January 2015

Mark E. Rupp*
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
R. Jennifer Cavalieri
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Elizabeth Lyden
Affiliation:
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
Jennifer Kucera
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
MaryAnn Martin
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
Teresa Fitzgerald
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
Kate Tyner
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
James R. Anderson
Affiliation:
Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
Trevor C. VanSchooneveld
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska
*
984031 Nebraska Medical Center, Omaha, NE 68198 (merupp@unmc.edu)

Abstract

Background.

Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs).

Design.

Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts.

Setting.

Academic medical center.

Patients.

All patients except neonates and infants.

Intervention and Measurements.

CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured.

Results.

Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%, P< .001). A significant decrease in infections due to Clostridium difficile was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57–0.89; P = .003) for 3-days-per-week CHG bathing and 0.41 (95% CI, 0.29–0.59; P < .001) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38–2.53; P =< .001), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported.

Conclusions.

CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized patients.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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