Chlorhexidine bathing reduces healthcare-associated BSI

A well-conducted systematic review and meta-analysis of the evidence around the effectiveness of chlorhexidine bathing to prevent healthcare-associated BSI has been published recently in BMC Infectious Diseases. The study concludes that chlorhexidine bathing significantly reduces the risk of healthcare-associated BSI by 41%. The reduction in the risk of BSI was consistent across different study designs (e.g. randomised vs. non-randomised), settings (e.g. ICU vs. non-ICU), and application modes of chlorhexidine (e.g. wipes vs. solution).

The study identified 26 studies that measured the impact of chlorhexidine bathing compared with a non-CHG product on the incidence of healthcare-associated BSI using any study design, including randomised or cluster-randomised trials (n=8), and non-randomised studies (n=18). 18 of the studies used a chlorhexidine wipe, and the remaining 8 studies used chlorhexidine solution. All but one of the studies used 2% chlorhexidine (one used 4%).

Overall, across the 26 studies, there was a statistically significant 41% reduction in the risk of healthcare-associated BSI associated with chlorhexidine bathing. This reduction in risk remained significant in several different sub-group analyses including randomised vs. non-randomised, ICU vs. non-ICU, and chlorhexidine wipes vs. solution.

A major feature of the findings was that compliance with the intervention was reported variably, with only three of the 26 studies reporting all five measures of fidelity (adherence to an intervention; exposure or dose; quality of delivery; participant responsiveness; and programme differentiation). This means that even if the intervention was implemented sub-optimally in many of the studies, it was still effective.

Methodological challenges aside, these findings provide further convincing evidence that chlorhexidine bathing reduces the risk of healthcare-associated BSI in a range of different setting and scenarios.