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Chlorhexidine Bathing in a Tertiary Care Neonatal Intensive Care Unit: Impact on Central Line–Associated Bloodstream Infections

Part of: WILLIAM JARVIS AWARD RECIPIENTS

Published online by Cambridge University Press:  10 May 2016

Caroline Quach ,
Aaron M. Milstone ,
Chantal Perpête ,
Mario Bonenfant ,
Dorothy L. Moore  and
Therese Perreault
Caroline Quach*
Affiliation:
Division of Infection Control, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada Division of Infectious Diseases, Department of Pediatrics, McGill University, Montreal, Quebec, Canada Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
Aaron M. Milstone
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
Chantal Perpête
Affiliation:
Division of Infection Control, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
Mario Bonenfant
Affiliation:
Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
Dorothy L. Moore
Affiliation:
Division of Infection Control, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada Division of Infectious Diseases, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
Therese Perreault
Affiliation:
Division of Neonatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
*
Montreal Children's Hospital, C1242-2300 Tupper Street, Montreal, Quebec H3H 1P3, Canada (caroline.quach@mcgill.ca)
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Abstract

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Background.

Despite implementation of recommended best practices, our central line-associated bloodstream infection (CLABSI) rates remained high. Our objective was to describe the impact of chlorhexidine gluconate (CHG) bathing on CLABSI rates in neonates.

Methods.

Infants with a central venous catheter (CVC) admitted to the neonatal intensive care unit from April 2009 to March 2013 were included. Neonates with a birth weight of 1,000 g or less, aged less than 28 days, and those with a birth weight greater than 1,000 g were bathed with mild soap until March 31, 2012 (baseline), and with a 2% CHG-impregnated cloth starting on April 1, 2012 (intervention). Infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with mild soap during the entire period. Neonatal intensive care unit nurses reported adverse events. Adjusted incidence rate ratios (aIRRs), using Poisson regression, were calculated to compare CLABSIs/1,000 CVC-days during the baseline and intervention periods.

Results.

Overall, 790 neonates with CVCs were included in the study. CLABSI rates decreased during the intervention period for CHG-bathed neonates (6.00 vs 1.92/1,000 CVC-days; aIRR, 0.33 [95% confidence interval (CI), 0.15-0.73]) but remained unchanged for neonates with a birth rate of 1,000 g or less and aged less than 28 days who were not eligible for CHG bathing (8.57 vs 8.62/1,000 CVC-days; aIRR, 0.86 [95% CI, 0.17-4.44]). Overall, 195 infants with a birth weight greater than 1,000 g and 24 infants with a birth weight of 1,000 g or less, aged 28 days or more, were bathed with CHG. There was no reported adverse event.

Conclusions.

We observed a decrease in CLABSI rates in CHG-bathed neonates in the absence of observed adverse events. CHG bathing should be considered if CLABSI rates remain high, despite the implementation of other recommended measures.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 2 , February 2014 , pp. 158 - 163
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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