Hostname: page-component-848d4c4894-r5zm4 Total loading time: 0 Render date: 2024-07-01T09:56:22.995Z Has data issue: false hasContentIssue false
  • English
  • Français

A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units

Published online by Cambridge University Press:  10 February 2016

Kristen V. Dicks ,
Eric Lofgren ,
Sarah S. Lewis ,
Rebekah W. Moehring ,
Daniel J. Sexton  and
Deverick J. Anderson
Kristen V. Dicks*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Eric Lofgren
Affiliation:
Network Dynamics and Simulation Science Lab, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, Virginia
Sarah S. Lewis
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Durham Veterans Affairs Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
*
Address correspondence to Kristen V. Dicks, MD, MPH, PO Box 102359, Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710 (Kristen.dicks@duke.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).

DESIGN

Interrupted time series analysis.

SETTING

The study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013.

PARTICIPANTS

All ICU patients at study hospitals during the study period.

METHODS

Of the 33 hospitals, 17 hospitals implemented CHG bathing during the study period, and 16 hospitals that did not perform CHG bathing served as controls. Primary pre-specified outcomes included ICU central-line–associated bloodstream infections (CLABSIs), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs). MRSA and VRE HAIs were also evaluated.

RESULTS

Chlorhexidine gluconate (CHG) bathing was associated with a significant downward trend in incidence rates of ICU CLABSI (incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.93–0.99), ICU primary BSI (IRR, 0.96; 95% CI, 0.94–0.99), VRE CLABSIs (IRR, 0.97; 95% CI, 0.97–0.98), and all combined VRE infections (IRR, 0.96; 95% CI, 0.93–1.00). No significant trend in MRSA infection incidence rates was identified prior to or following the implementation of CHG bathing.

CONCLUSIONS

In this multicenter, real-world analysis of the impact of CHG bathing, hospitals that implemented CHG bathing attained a decrease in ICU CLABSIs, ICU primary BSIs, and VRE CLABSIs. CHG bathing did not affect rates of specific or overall infections due to MRSA. Our findings support daily CHG bathing of ICU patients.

Infect Control Hosp Epidemiol 2016;37:791–797

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 791 - 797
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION. An abstract containing preliminary data was presented at IDWeek, October 8, 2015, San Diego, California.

References

REFERENCES

1. Magill, S, Edwards, J, Bramberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
2. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–2046.CrossRefGoogle ScholarPubMed
3. Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:53–59.Google Scholar
4. Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Outcome and attributable mortality in critically ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus . Arch Intern Med 2002;162:2229–2235.CrossRefGoogle ScholarPubMed
5. Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999;20:408–411.CrossRefGoogle ScholarPubMed
6. Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.Google Scholar
7. DiazGranados, CA, Zimmer, SM, Klein, M, Jernigan, JA. Comparison of mortality associated with vancomycin-resistant and vancomycin-susceptible enterococcal bloodstream infections: a meta-analysis. Clin Infect Dis 2005;41:327–333.CrossRefGoogle ScholarPubMed
8. Popovich, KJ, Lyles, R, Hayes, R, et al. Relationship between chlorhexidine gluconate skin concentration and microbial density on the skin of critically ill patients bathed daily with chlorhexidine gluconate. Infect Control Hosp Epidemiol 2012;33:889–896.Google Scholar
9. Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30:959–963.Google Scholar
10. Vernon, MO, Hayden, MK, Trick, WE, et al. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med 2006;166:306–312.CrossRefGoogle Scholar
11. Darouiche, RO, Wall, MJ Jr, Itani, KM, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis. N Engl J Med 2010;362:18–26.Google Scholar
12. Armellino, D, Woltmann, J, Parmentier, D, et al. Modifying the risk: once-a-day bathing “at risk” patients in the intensive care unit with chlorhexidine gluconate. Am J Infect Control 2014;42:571–573.CrossRefGoogle ScholarPubMed
13. Cassir, N, Thomas, G, Hraiech, S, et al. Chlorhexidine daily bathing: impact on health care-associated infections caused by Gram-negative bacteria. Am J Infect Control 2015;43:640–643.CrossRefGoogle ScholarPubMed
14. Popovich, KJ, Hota, B, Hayes, R, Weinstein, RA, Hayden, MK. Daily skin cleansing with chlorhexidine did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit. Insensive Care Med 2010;36:854–858.CrossRefGoogle ScholarPubMed
15. Viray, MA, Morley, JC, Coopersith, CM, Kollef, MH, Fraser, VJ, Warren, DK. Daily bathing with chlorhexidine-based soap and the prevention of Staphylococcus aureus transmission and infection. Infect Control Hosp Epidemiol 2014;35:243–250.Google Scholar
16. Climo, MW, Sepkowitz, KA, Zuccotti, G, et al. The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009;37:1858–1865.Google Scholar
17. Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533–542.CrossRefGoogle ScholarPubMed
18. Noto, MJ, Domenico, HJ, Byrne, DW, et al. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA 2015;313:369–378.Google Scholar
19. Huang, SS, Septimus, E, Kleinman, K, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med 2013;368:2255–2265.Google Scholar
20. Milstone, AM, Elward, A, Song, X, et al. Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicenter, cluster-randomised, crossover trial. Lancet 2013;381:1099–1106.CrossRefGoogle ScholarPubMed
21. Chen, W, Li, S, Li, L, Wu, X, Zhang, W. Effects of daily bathing with chlorhexidine and acquired infection of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus: a meta-analysis. J Thorac Dis 2013;5:518–524.Google Scholar
22. O’Horo, JC, Silva, GL, Munoz-Price, LS, Safdar, N. The efficacy of daily bathing with chlorhexidine for reducing healthcare-associated bloodstream infections: a meta-analysis. Infect Control Hosp Epidemiol 2012;33:257–267.Google Scholar
23. Anderson, DJ, Miller, BA, Chen, LF, et al. The network approach for prevention of healthcare-associated infections: long-term effect of participation in the Duke Infection Control Outreach Network. Infect Control Hosp Epidemiol 2011;32:315–322.CrossRefGoogle Scholar
24. Moehring, RW, Lofgren, ET, Anderson, DJ. Impact of change to molecular testing for Clostridium difficile infection on healthcare facility-associated incedence rates. Infect Control Hosp Epidemiol 2013;34:1055–1061.Google Scholar
25. Karki, S, Cheng, AC. Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. J Hosp Infect 2012;82:71–84.CrossRefGoogle ScholarPubMed
26. Marschall, J, Mermel, LA, Fakih, M, et al. Strategies to prevent central line–associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:753–771.CrossRefGoogle ScholarPubMed