219. Impact of Chlorhexidine Bathing on Central Line Associated Bloodstream Infections (CLABSI) Rates in a Tertiary-Care NICU: A Quasi-Experimental Study
Session: Poster Abstract Session: Criticare, HAIs: Pneumonia and Chlorhexidine
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 219_IDWPOSTER.pdf (626.8 kB)
  • Background:

    Despite the implementation of recommended measures for central line associated bloodstream infections (CLABSI) prevention, rates remained high in our NICU. Bathing with chlorhexidine (CHG) wipes was implemented in April 2012 and we aimed to describe its impact on CLABSI rates.

    Methods:

    Infants admitted to The Montreal Children’s Hospital NICU between April 1st 2009 and March 31st2013 were included in the study. Active CLABSI surveillance using standard  definitions is done prospectively. As of April 2012, using a quasi-experimental design, where the only difference in patient care was the implementation of CHG bathing, we recommended the use of 2% aqueous CHG wipes for infants who had a central venous catheter (CVC) in place. CHG bathing was recommended for all infants whose birth weight (BW) was ≥1000 g (twice a week if < 29 weeks gestation; q 2 days if 29-35 weeks; daily if > 35 weeks) or started when the infant reached 28 days of life if BW < 1000 g (q 2 days until 2 months of age, then daily). Adverse events reporting was done by NICU nurses and reported to the program manager. Incidence rate ratios (IRR) were calculated for pooled CLABSI rates (/1000 CVC days) for 2009-2012 (reference period) and 2012-2013 (intervention period) (STATA 12.0) for those eligible and not eligible for CHG bathing in an intent-to-treat analysis. 

    Results:

    Overall, 24 infants with BW < 1000 g (mean BW 785±122g) and 193 infants with BW ≥ 1000 g (mean BW 2846± 943g) were CHG eligible during this past year. A decrease in CLABSI rates for infants in the CHG eligible group was observed between the reference and intervention period (6.00 vs. 1.92/1000 CVL days; IRR = 0.32 [95%CI 0.12; 0.70]). However, CLABSI rates in infants who were not in the CHG eligible group remained unchanged (8.57 vs. 8.62; IRR = 1.01 [95%CI 1.00; 5.62]). The overall CLABSI rate decreased from 6.17 to 2.32 (IRR = 0.38; 95%CI 0.16; 0.76). There was no reported adverse event. 

    Conclusion:

    We observed a significant decrease in CLABSI rates in the CHG eligible group (70%), which impacted the overall CLABSI rates (62% reduction). No change in rates was seen, however, in the CHG non-eligible group. The implementation of CHG bathing in our NICU was not associated with adverse events and should be considered when CLABSI rates remain high despite the implementation of other recommended measures.

    Caroline Quach, MD MSc1,2, Chantal Perpête, RN, LSH, LSHH1, Milagros Gonzales, MSc1, Dorothy Moore, MD, PhD1, Mario Bonenfant, RN3, Martine Chagnon, RN3, Martine Claveau, NNP3 and Thérèse Perreault, MD3, (1)Division of Infectious Diseases; Department of Pediatrics, The Montreal Children's Hospital, Montreal, QC, Canada, (2)Epidemiology, Biostatistics, and Occupational Health, Mc Gill University, Montreal, QC, Canada, (3)Division of Neonatology; Department of Pediatrics, The Montreal Children's Hospital, Montreal, QC, Canada

    Disclosures:

    C. Quach, None

    C. Perpête, None

    M. Gonzales, None

    D. Moore, None

    M. Bonenfant, None

    M. Chagnon, None

    M. Claveau, None

    T. Perreault, None

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