The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial.
OBJECTIVE
Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patients.


METHODS
Six ICUs at four academic centers measured the incidence of MRSA and VRE colonization and BSI during a period of bathing with routine soap for 6 months and then compared results with a 6-month period where all admitted patients received daily bathing with a chlorhexidine solution. Changes in incidence were evaluated by Poisson and segmented regression modeling.


METHODS
Daily bathing with a chlorhexidine-containing solution.


RESULTS
Acquisition of MRSA decreased 32% (5.04 vs. 3.44 cases/1000 patient days, p = 0.046) and acquisition of VREdecreased 50% (4.35 vs. 2.19 cases/1000 patient days, p = 0.008) following the introduction of daily chlorhexidine bathing. Segmented regression analysis demonstrated significant reductions in VRE bacteremia (p = 0.02) following the introduction of chlorhexidine bathing. VRE-colonized patients bathed with chlorhexidine had a lower risk of developing VRE bacteremia (relative risk 3.35; 95% confidence interval 1.13-9.87; p = 0.035), suggesting that reductions in the level of colonization led to the observed reductions in BSI.


CONCLUSIONS
We conclude that daily chlorhexidine bathing among ICU patients may reduce the acquisition of MRSA and VRE. The approach is simple to implement and inexpensive and may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated BSI.
Climo
Michael W
MW
Hospital Epidemiologist (MWC), Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, VA, USA.
Sepkowitz
Kent A
KA
Zuccotti
Gianna
G
Fraser
Victoria J
VJ
Warren
David K
DK
Perl
Trish M
TM
Speck
Kathleen
K
Jernigan
John A
JA
Robles
Jaime R
JR
Wong
Edward S
ES
D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001494:Baths; D017848:Blood-Borne Pathogens; D002710:Chlorhexidine / Q000008:administration & dosage*; D016983:Enterococcus / Q000187:drug effects*; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D020713:Vancomycin Resistance
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine