Background: Daily chlorhexidine gluconate (CHG) bathing of patients in intensive care units (ICUs) has been extensively studied yet has yielded inconsistent results. Our goal was to estimate the effect of CHG bathing on the incidence of ICU-acquired infections using time-trended surveillance data from a large sample of community hospitals.
Methods: We performed an interrupted time series analysis of 33 community hospitals in the Duke Infection Control Outreach Network from January 2008 through December 2013. 17 hospitals implemented CHG bathing during the study period; the remaining 16 hospitals served as controls. Primary outcomes included ICU central line-associated bloodstream infections (CLABSI), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI). We also tracked MRSA infections, including CLABSI, VAP, CAUTI, "other" MRSA infections, and all MRSA infections combined. We examined the same outcomes for VRE infections, excluding VAP. Hospital patient mix and active MRSA screening were evaluated as confounders. We estimated incident rate ratios and 95% confidence intervals for the effect of implementing CHG bathing on the above outcomes, as well as linear trends in incidence both before and after the switch.
Results: Hospitals that implemented CHG bathing had higher aggregate incidence of combined MRSA infections, combined VRE infections, and all ICU infections compared to control hospitals. CHG use was, however, associated with a significant downward trend in incidence of CLABSI (Figure 1), primary BSI (Figure 2), VRE CLABSI (Figure 3), and all combined VRE infections. There was a significant downward trend of the incidence of VAP and VRE CAUTI prior to CHG bathing implementation; however, this trend was not seen after the switch. There were no significant trends in MRSA infection incidence prior to or following CHG bathing implementation.
Conclusion: Hospitals that implemented CHG bathing had a decrease in CLABSIs, primary BSIs, and VRE CLABSIs, but CHG bathing did not affect MRSA infection rates. Our findings support daily CHG bathing of ICU patients, particularly in community hospitals with high incidence rates of CLABSI, primary BSI, and VRE CLABSI.
R. W. Moehring, None
M. J. Durkin, None
A. W. Baker, None
L. F. Chen, None
D. J. Sexton, None
S. S. Lewis, None
D. Anderson, None