title: Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability.
abstract: BACKGROUND
  Chlorhexidine bathing has been associated with reductions in healthcare-associated bloodstream infection. To determine the impact and sustainability of the effect of chlorhexidine bathing on central venous catheter-associated bloodstream infection, we performed a prospective, 3-phase, multiple-hospital study.
  
  
  METHODS
  In the medical intensive care unit and the respiratory care unit of a tertiary care hospital and the medical-surgical intensive care units of 4 community hospitals, rates of central venous catheter-associated bloodstream infection were collected prospectively for each period. Pre-intervention (phase 1) patients were bathed with soap and water or nonmedicated bathing cloths; active intervention (phase 2) patients were bathed with 2% chlorhexidine gluconate cloths with the number of baths administered and skin tolerability assessed; post-intervention (phase 3) chlorhexidine bathing was continued but without oversight by research personnel. Central venous catheter-associated bloodstream infection rates were compared over study periods using Poisson regression.
  
  
  RESULTS
  Compared with pre-intervention, during active intervention there were significantly fewer central venous catheter-associated bloodstream infections (6.4/1000 central venous catheter days vs 2.6/1000 central venous catheter days, relative risk, 0.42; 95% confidence interval, 0.25-0.68; P<.001), and this reduction was sustained during post-intervention (2.9/1000 central venous catheter days; relative risk, 0.46; 95% confidence interval, 0.30-0.70; P<.001). During the active intervention period, compliance with chlorhexidine bathing was 82%. Few adverse events were observed.
  
  
  CONCLUSIONS
  In this multiple-hospital study, chlorhexidine bathing was associated with significant reductions in central venous catheter-associated bloodstream infection, and these reductions were sustained post-intervention when chlorhexidine bathing was unmonitored. Chlorhexidine bathing was well tolerated and is a useful adjunct to reduce central venous catheter-associated bloodstream infection.
authors.affiliation: Infection Prevention and Control Department, Westchester Medical Center, Valhalla, New York 10595, USA. montecalvom@wcmc.com
authors.forename: Marisa A
authors.initials: MA
authors.lastname: Montecalvo
authors.forename: Donna
authors.initials: D
authors.lastname: McKenna
authors.forename: Robert
authors.initials: R
authors.lastname: Yarrish
authors.forename: Lynda
authors.initials: L
authors.lastname: Mack
authors.forename: George
authors.initials: G
authors.lastname: Maguire
authors.forename: Janet
authors.initials: J
authors.lastname: Haas
authors.forename: Lawrence
authors.initials: L
authors.lastname: DeLorenzo
authors.forename: Norine
authors.initials: N
authors.lastname: Dellarocco
authors.forename: Barbara
authors.initials: B
authors.lastname: Savatteri
authors.forename: Addie
authors.initials: A
authors.lastname: Rosenthal
authors.forename: Anita
authors.initials: A
authors.lastname: Watson
authors.forename: Debra
authors.initials: D
authors.lastname: Spicehandler
authors.forename: Qiuhu
authors.initials: Q
authors.lastname: Shi
authors.forename: Paul
authors.initials: P
authors.lastname: Visintainer
authors.forename: Gary P
authors.initials: GP
authors.lastname: Wormser
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000191:economics / Q000494:pharmacology*; D016470:Bacteremia / Q000517:prevention & control*; D001494:Baths / Q000191:economics; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics / Q000494:pharmacology; D006801:Humans
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine