Daily Chlorhexidine Baths Cut Infection Rates

A new study demonstrates that scrubbing children in pediatric intensive care units (PICUs) with a chlorhexidine gluconate (CHG) solution daily cut the incidence of bacteremia by more than 35%.

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) conducted a randomized, two-period crossover trial involving 10 PICUs at five hospitals in the United States. The hospitals were randomly assigned a daily bathing routine for admitted patients older than 2 months, which involved either standard bathing practices or using a cloth impregnated with 2% CHG, for a period of six months. The units switched to the alternative bathing method for a second six-month period. The primary outcome was an episode of bacteremia, based on intention-to-treat (ITT) and per-protocol (PP) analyses.

In all, 6,482 admissions were screened for eligibility; 1,521 admitted patients were excluded because their length of stay was less than two days, and 14 refused to participate. In the ITT population, a nonsignificant reduction in incidence of bacteremia was noted with CHG bathing compared with standard practices. In the PP population, the incidence of bacteremia in PICUs using the daily chlorhexidine baths was 3.28 per 1,000 patient-days, compared with 4.93 per 1,000 patient-days with standard bathing practices. No serious study-related adverse events were recorded, and the incidence of CHG-associated skin reactions was 1.2 per 1,000 days.

Most of the differences were substantially attenuated in the ITT analysis, in which many children admitted to units performing the intervention received the control treatment, because consent to the protocol was not obtained. One exception, however, was the risk of bacteremia in patients with central venous catheters. In this group, the adjusted incidence rate with the intervention was 0.65, virtually identical to the per-protocol finding. The study was published on January 28, 2013, in the Lancet.

“We have shown that a simple and easily implementable intervention decreased bacteremia in critically ill children,” concluded lead author Aaron Milstone, MD, and colleagues. “Broad use of this intervention could reduce morbidity and costs from bacteremia in this vulnerable and understudied population.”

Related Links:
Johns Hopkins University