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Does Chlorhexidine Bathing in Adult Intensive Care Units Reduce Blood Culture Contamination? A Pragmatic Cluster-Randomized Trial

Published online by Cambridge University Press:  10 May 2016

Edward J. Septimus ,
Mary K. Hayden ,
Ken Kleinman ,
Taliser R. Avery ,
Julia Moody ,
Robert A. Weinstein ,
Jason Hickok ,
Julie Lankiewicz ,
Adrijana Gombosev  and
Katherine Haffenreffer
...Show all authors
Edward J. Septimus
Affiliation:
Hospital Corporation of America, Nashville, Tennessee Texas A&M Health Science Center, College of Medicine, Texas A&M University, Houston, Texas
Mary K. Hayden
Affiliation:
Rush University Medical Center, Chicago, Illinois
Ken Kleinman
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard University, Boston, Massachusetts
Taliser R. Avery
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard University, Boston, Massachusetts
Julia Moody
Affiliation:
Hospital Corporation of America, Nashville, Tennessee
Robert A. Weinstein
Affiliation:
Cook County Health and Hospitals System, Chicago, Illinois
Jason Hickok
Affiliation:
Hospital Corporation of America, Nashville, Tennessee
Julie Lankiewicz
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard University, Boston, Massachusetts
Adrijana Gombosev
Affiliation:
University of California Irvine School of Medicine, Orange, California
Katherine Haffenreffer
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard University, Boston, Massachusetts
Rebecca E. Kaganov
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard University, Boston, Massachusetts
John A. Jernigan
Affiliation:
Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, and for the Agency for Healthcare Research and Quality Developing Evidence to Inform Decisions about Effectiveness Network and Healthcare-Associated Infections Program and the CDC Prevention Epicenters Program
Jonathan B. Perlin
Affiliation:
Hospital Corporation of America, Nashville, Tennessee
Richard Piatt
Affiliation:
Harvard Medical School and Harvard Pilgrim Health Care Institute, Harvard University, Boston, Massachusetts
Susan S. Huang
Affiliation:
University of California Irvine School of Medicine, Orange, California
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Objective.

To determine rates of blood culture contamination comparing 3 strategies to prevent intensive care unit (ICU) infections: screening and isolation, targeted decolonization, and universal decolonization.

Design.

Pragmatic cluster-randomized trial.

Setting.

Forty-three hospitals with 74 ICUs; 42 of 43 were community hospitals.

Patients.

Patients admitted to adult ICUs from July 1, 2009, to September 30, 2011.

Methods.

After a 6-month baseline period, hospitals were randomly assigned to 1 of 3 strategies, with all participating adult ICUs in a given hospital assigned to the same strategy. Arm 1 implemented methicillin-resistant Staphylococcus aureus (MRSA) nares screening and isolation, arm 2 targeted decolonization (screening, isolation, and decolonization of MRSA carriers), and arm 3 conducted no screening but universal decolonization of all patients with mupirocin and chlorhexidine (CHG) bathing. Blood culture contamination rates in the intervention period were compared to the baseline period across all 3 arms.

Results.

During the 6-month baseline period, 7,926 blood cultures were collected from 3,399 unique patients: 1,099 sets in arm 1, 928 in arm 2, and 1,372 in arm 3. During the 18-month intervention period, 22,761 blood cultures were collected from 9,878 unique patients: 3,055 sets in arm 1, 3,213 in arm 2, and 3,610 in arm 3. Among all individual draws, for arms 1,2, and 3, the contamination rates were 4.1%, 3.9%, and 3.8% for the baseline period and 3.3%, 3.2%, and 2.4% for the intervention period, respectively. When we evaluated sets of blood cultures rather than individual draws, the contamination rate in arm 1 (screening and isolation) was 9.8% (N = 108 sets) in the baseline period and 7.5% (N = 228) in the intervention period. For arm 2 (targeted decolonization), the baseline rate was 8.4% (N = 78) compared to 7.5% (N = 241) in the intervention period. Arm 3 (universal decolonization) had the greatest decrease in contamination rate, with a decrease from 8.7% (N = 119) contaminated blood cultures during the baseline period to 5.1% (N = 184) during the intervention period. Logistic regression models demonstrated a significant difference across the arms when comparing the reduction in contamination between baseline and intervention periods in both unadjusted (P = .02) and adjusted (P = .02) analyses. Arm 3 resulted in the greatest reduction in blood culture contamination rates, with an unadjusted odds ratio (OR) of 0.56 (95% confidence interval [CI], 0.044-0.71) and an adjusted OR of 0.55 (95% CI, 0.43-0.71).

Conclusion.

In this large cluster-randomized trial, we demonstrated that universal decolonization with CHG bathing resulted in a significant reduction in blood culture contamination.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S17 - S22
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

References

1. Weinbaum, FI, Lavie, S, Danek, M, Sixsmith, D, Heinrich, GF, Mill, SS. Doing it right the first time: quality improvement and the contaminant blood culture, J Clin Microbiol 1997;35(3):563–565.CrossRefGoogle ScholarPubMed
2. Weinstein, MP. Blood culture contamination: persisting problems and partial progress. J Clin Microbiol 2003;41:2275–2278.CrossRefGoogle ScholarPubMed
3. Clinical and Laboratory Standards Institute (CLSI). Principles and Procedures for Blood Cultures: Approved Guideline. Wayne, PA: CLSI; 2007. CLSI document M47-A.Google Scholar
4. Hall, KK, Lyman, IA. Updated review of blood culture contamination. Clin Microbiol Rev 2006; 19(4) :788–802.CrossRefGoogle ScholarPubMed
5. Bekeris, LG, Tworek, JA, Walsh, MK, et al. Trends in blood culture contamination: a College of American Pathologists Q-Tracks study of 356 institutions. Arch Pathol Lab Med 2005;129:1222–1225.CrossRefGoogle ScholarPubMed
6. Stohl, S, Benenson, S, Sviri, S, et al. Blood culture at central line insertion in the intensive care unit: comparison with peripheral venipuncture. J Clin Microbiol 2011;49:2398–2403.CrossRefGoogle ScholarPubMed
7. Darby, JM, Linden, P, Pasculle, W, Saul, M. Utilization and diagnostic yield of blood cultures in a surgical intensive care unit. Crit Care Med 1997;25:989–994.CrossRefGoogle Scholar
8. Bates, DW, Goldman, L, Lee, TH. Contaminant blood cultures and resource utilization: the true consequences of false-positive results. JAMA 1991;265:365–369.CrossRefGoogle ScholarPubMed
9. Pien, BC, Sundaram, P, Raoof, N, et al. The clinical and prognostic importance of positive blood cultures in adults. Am J Med 2010; 123(9):819–828.CrossRefGoogle ScholarPubMed
10. Souvenir, D, Anderson, DE Jr, Palpant, S, et al. Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients, J Clin Microbiol 1998;36: 1923–1926.CrossRefGoogle ScholarPubMed
11. Gander, RM, Byrd, L, DeCrescenzo, M, et al. Impact of blood cultures drawn by phlebotomy on contamination rates and health care costs in a hospital emergency department, J Clin Microbiol 2009;47:1021–1024.CrossRefGoogle Scholar
12. Alahmadi, YM, Aldeyab, MA, McElnay, JC, et al. Clinical and economic impact of contaminated blood cultures within the hospital setting. J Hosp Infect 2011;77(3):233–236.CrossRefGoogle ScholarPubMed
13. Viagappan, M, Kelsey, MC. The origin of coagulase-negative staphylococci isolated from blood cultures, J Hosp Infect 1995; 30:217–223.CrossRefGoogle ScholarPubMed
14. Mylotte, JM, Tayara, A. Blood cultures: clinical aspects and controversies. Eur J Clin Microbiol Infect 2000;19:157–163.CrossRefGoogle ScholarPubMed
15. Washer, LL, Chenoweth, C, Kim, H-W, et al. Blood culture contamination: a randomized trial evaluating the comparative effectiveness of 3 skin antiseptic interventions. Infect Control Hosp Epidemiol 2013;34:15–21.CrossRefGoogle ScholarPubMed
16. Bleasdale, SC, Trick, WE, Gonzalez, IM, et al. Effectiveness of chlorhexidene bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167:2073–2079.CrossRefGoogle Scholar
17. Popovich, KJ, Hota, B, Hayes, BA, et al. Effectiveness of routine patient cleansing with chlorhexidene gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30:959–963.CrossRefGoogle Scholar
18. Popovich, KJ, Hota, B, Hayes, BA, et al. Daily skin cleansing with chlorhexidene did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit. Intensive Care Med 2010;36:854–858.CrossRefGoogle 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.CrossRefGoogle ScholarPubMed
20. Popovich, KJ, Lyles, R, Hayes, BA, 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.CrossRefGoogle ScholarPubMed