Effect of chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients.
OBJECTIVE
To demonstrate whether daily bathing with cloths impregnated with 2% chlorhexidine gluconate will decrease colonization of resistant bacteria and reduce the rates of health care-associated infections in critically injured patients.


METHODS
Retrospective analysis of data collected 6 months before and after institution of a chlorhexidine bathing protocol.


METHODS
A 12-bed intensive care unit in a level I trauma center.


METHODS
Two hundred eighty-six severely injured patients underwent daily chlorhexidine bathing during the 6-month intervention; 253 patients were bathed without chlorhexidine prior to the intervention.


METHODS
Daily chlorhexidine bathing.


METHODS
Rates of ventilator-associated pneumonia (VAP), bloodstream infection, and colonization with resistant organisms (methicillin-resistant Staphylococcus aureus [MRSA] or Acinetobacter species).


RESULTS
Baseline patient and injury characteristics were similar between cohorts. Patients receiving chlorhexidine baths were significantly less likely to acquire a catheter-related bloodstream infection than comparators (2.1 vs 8.4 infections per 1000 catheter-days, P = .01). The incidence of VAP was not affected by chlorhexidine baths (16.9 vs 21.6 infections per 1000 ventilator-days in those with vs those without chlorhexidine baths, respectively, P = .30). However, patients who received chlorhexidine baths were less likely to develop MRSA VAP (1.6 vs 5.7 infections per 1000 ventilator-days, P = .03). The rate of colonization with MRSA (23.3 vs 69.3 per 1000 patient-days, P < .001) and Acinetobacter (1.0 vs 4.6 per 1000 patient-days, P = .36) was significantly lower in the chlorhexidine group than in the comparison group.


CONCLUSIONS
Daily bathing of trauma patients with cloths impregnated with 2% chlorhexidine gluconate is associated with a decreased rate of colonization by MRSA and Acinetobacter and lower rates of catheter-related bloodstream infection and MRSA VAP.
Evans
Heather L
HL
Department of Surgery, Harborview Medical Center, 325 9th Ave., Seattle, WA 98104, USA. hlevans@u.washington.edu
Dellit
Timothy H
TH
Chan
Jeannie
J
Nathens
Avery B
AB
Maier
Ronald V
RV
Cuschieri
Joseph
J
D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000150:complications / Q000517:prevention & control*; D001494:Baths; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003428:Cross Infection / Q000150:complications / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications
D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine