Chlorhexidine daily bathing reduces infections: multicentre study in the US

An ambitious study involving ICUs in 33 community hospitals in the US over a period over five years evaluated the impact of chlorhexidine (CHG) daily bathing. ICUs in 17 hospitals implemented CHG daily bathing, whereas 16 ICUs did not, and served as controls. The study evaluated any potential changes in a host of infection-related outcomes, including CLABSI, any BSI, VAP, CAUTI, and VRE and MRSA HCAIs. The ICUs were not randomised to the intervention, but it’s a pretty good sample size so you’d expect any variability to be smoothed out naturally. However, it is worth nothing that 88% of the hospitals that implemented CHG bathing also had an active MRSA screening programme, whereas only 50% of the hospitals that did not implement CHG bathing had an MRSA screening programme. Thus, implementing CHG could be a marker of a more complete infection prevention and control programme, which could confound these findings. Perhaps related to this is the finding that MRSA, VRE, CAUTI, CLABSI, all primary BSI and VAP were all more common in the ICUs that implemented CHG, suggesting that the baseline characteristics of the units that chosen to implement CHG were different to those that did not. Nonetheless, the results from the time series analysis (which evaluated whether there were changes in the rate of these HCAI-related outcomes) are impressive: CLABSIs were reduced by 59%, primary BSIs by 36%, and VRE CLABSIs by 33% on the units that were using CHG daily bathing. There were no changes in the rate of MRSA-related HCAI metrics. This study performed in a large number of community hospitals (rather than large academic teaching hospitals) provides real-world data that CHG bathing reduces the rate of important HCAIs. However, it also illustrates that CHG bathing is not a silver bullet and needs for form part of a multifaceted strategy to prevent HCAI on ICUs.