Surgical Scrub Solution Protects Patients Too

Giving critically ill hospital patients a daily bath with chlorhexidine can dramatically cut down the number of patients who develop potentially deadly bloodstream infections, according to a new study.

Researchers from Johns Hopkins [University] Hospital (Baltimore, MD, USA) and five other institutions tracked daily neck-to-toe sponge baths given to 2,650 intensive care unit (ICU) patients at six different U.S. hospitals between December 2004 and January 2006. The study patients were bathed with a mild, 4% solution of chlorhexidine glutonate, while an equal number of control patients were bathed with plain soap and water. Each patient was tested for infectious bacteria within 48 hours of admission and then weekly thereafter with either nasal or buttock swabs, and for the remainder of their hospital stay.

Weekly swab testing found 32% fewer patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) and 50% fewer cases of vancomycin-resistant Enterococci (VRE), compared to the control subjects. Among some 500 patients whose stay in hospital was longer (at least 10 days), 11 who were washed with chlorhexidine had MRSA, and 5 developed bloodstream infections. By contrast, MRSA was detected in 27 of the control group, 8 developing bloodstream infections. Similarly, with VRE, 9 patients in the chlorhexidine group had bloodstream infections, while 33 were infected in the plain-soap group. No skin rashes or adverse events were detected in the study group during the test period. The study was published in the June 2009 issue of the journal Critical Care Medicine.

"Our results show that using chlorhexidine as a daily washing agent is a simple, effective and relatively cheap way to protect the health of our most vulnerable patients," said study co-investigator Trish Perl, M.D., director of hospital epidemiology and infection control at Johns Hopkins. "Altering the daily bathing routine is a simple and effective means of doing so because it involves no additional workload for nurses."

Chlorhexidine is a chemical antiseptic that is bactericidal to both Gram-positive and Gram-negative microbes; it is also bacteriostatic. The mechanism of action is by membrane disruption, and not ATPase inactivation as previously thought. It also shows activity with enveloped viruses, though this has not been extensively investigated. Chlorhexidine gluconate is often used as an active ingredient in mouthwashes designed to reduce dental plaque and oral bacteria, and also as a skin cleanser, mainly used as a surgical scrub, but is also available as a wound wash.

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