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Effectiveness of Routine Patient Cleansing with Chlorhexidine Gluconate for Infection Prevention in the Medical Intensive Care Unit

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Kyle J. Popovich ,
Bala Hota ,
Robert Hayes ,
Robert A. Weinstein  and
Mary K. Hayden
Kyle J. Popovich*
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Department of Medicine, Section of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
Bala Hota
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Department of Medicine, Section of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
Robert Hayes
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Robert A. Weinstein
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois Department of Medicine, Section of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
Mary K. Hayden
Affiliation:
Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
*
Department of Medicine, Section of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, 1900 West Polk Street, 12th Floor, Chicago, IL 60612 ([email protected])
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Abstract

Background.

Controlled studies that took place in medical intensive care units (MICUs) have demonstrated that bathing patients with Chlorhexidine gluconate (CHG) can reduce skin colonization with potential pathogens and can lessen the risk of central venous catheter (CVC)-associated bloodstream infection (BSI).

Objective.

TO examine, without oversight of practice by research study staff, the effectiveness or real-world effect of patient cleansing with CHG on rates of CVC-associated BSI.

Design.

In the fall of 2005, the MICU at Rush University Medical Center discontinued bathing patients daily with soap and water and substituted skin cleansing with no-rinse, 2% CHG-impregnated cloths. This change was a clinical management decision without research input.

Setting.

A 21-bed MICU at Rush University Medical Center.

Patients.

Patients hospitalized in the MICU during the period from September 2004 through October 2006.

Methods.

In a pre-post study design, we gathered data from administrative and laboratory databases, infection control practitioner logs, and patient medical charts to compare rates of CVC-associated BSI and blood culture contamination between the baseline soap-and-water bathing period (September 2004-October 2005) and the CHG bathing period (November 2005-October 2006). Rates of secondary BSI, Clostridium difficile infection (CDI), ventilator-associated pneumonia (VAP), and urinary tract infection (UTI) served as control variables that were not expected to be affected by CHG bathing.

Results.

Bathing with CHG was associated with a statistically significant decrease in the rate of CVC-associated BSI (from 5.31 to 0.69 cases per 1,000 CVC-days; P = .006) and in the rate of blood culture contamination (from 6.99 to 4.1 cases per 1,000 patient-days; P = .04). Rates of secondary BSI, CDI, VAP, and UTI did not change significantly.

Conclusions.

In our analysis of real-world practice, daily bathing of MICU patients with CHG was effective at reducing rates of CVC-associated BSI and blood culture contamination. Controlled studies are needed to determine whether these beneficial effects extend outside the MICU.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 10 , October 2009 , pp. 959 - 963
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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