222. Impact of Chlorhexidine Bathing on Cental Line Associated Bloodstream Infections in Adult Intensive Care Units
Session: Poster Abstract Session: Criticare, HAIs: Pneumonia and Chlorhexidine
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Background:

Chlorhexidine (CHG) bathing has been associated with reduction in central line associated bloodstream infection (CLABSI) rates in intensive care units (ICU). However, baseline CLABSI rates in these studies have been high [3.3-16.8/1000 central line days (CLD)]. It is unclear if CHG bathing can further reduce CLABSI rates in the setting of established low rates. We instituted daily CHG bathing in all adult ICU patients at our institution in July 2010, and retrospectively analyzed the impact on CLABSI, overall hospital-acquired BSI (HABSI), and blood culture contamination (BCC) rates during initial roll-out (Phase I) and sustainment (Phase II), compared to baseline. 

Methods:

Data was analyzed retrospectively for all adult ICU HABSI from Aug 2008 - Feb 2013, using a Hospital Epidemiology surveillance database. All ICU blood cultures were reviewed using CDC/NHSN criteria, and BCC data was measured using standard criteria. CHG bathing was performed by mixing a 4-oz bottle of 4% CHG in a basin with water and applying with a wash towel. CHG bathing compliance was measured as #CHG bottles used / patient days (PD). Time periods were divided into baseline (Aug 2008 - Jul 2010, soap and water), Phase I (Aug 2010 - May 2011, introduction of CHG bathing), and Phase II (Jun 2011 to Feb 2013, CHG bathing compliance >70%). Rates between time periods were compared using student’s t-tests (SAS v9.3). 

Results:

Our dataset included 117,662 PD and 79,284 CLD across 55 months.

 

Baseline

Phase I

Phase II

CHG Bathing Compliance

--

48.7%

77.2%

CLABSI/1000 CLD

0.52

0.63 (NS)

0.45 (NS)

Staphylococcus spp. CLABSI/1000 CLD

0.23

0.19 (NS)

0.07 (p=0.04)

HABSI/1000 PD

3.40

4.73 (p=0.04)

4.00 (NS)

BCC/1000 PD

7.95

9.29 (NS)

5.98 (p=0.01)

NS = not significant (p>0.05). All p-values refer to comparison with baseline.

Conclusion:

In the setting of low baseline CLABSI rates, CHG bathing was associated with a significant reduction (70%) in the subset of CLABSI attributable to Staphylococcus spp., as well as a significant reduction (25%) in BCC rates. Notably, these reductions were only observed when CHG bathing compliance was relatively high (77%). CHG bathing is not associated with a reduction in overall HABSI or CLABSI when baseline rates are already low.

Atul Kothari, MD1, Jonathan Grein, MD2, Meghan Madhusudhan3 and Rekha Murthy, MD2, (1)Infectious Diseases, Cedars Sinai Medical Center, Los Angeles, CA, (2)Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, CA, (3)Hospital Epidemiology, Cedars Sinai Medical Center, Los Angeles, CA

Disclosures:

A. Kothari, None

J. Grein, None

M. Madhusudhan, None

R. Murthy, None

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