title: Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections.
abstract: BACKGROUND
  Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs).
  
  
  METHODS
  Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  All patients except neonates and infants.
  
  
  METHODS
  CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured.
  
  
  RESULTS
  Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%, [Formula: see text]). A significant decrease in infections due to Clostridium difficile was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57-0.89; [Formula: see text]) for 3-days-per-week CHG bathing and 0.41 (95% CI, 0.29-0.59; [Formula: see text]) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38-2.53; [Formula: see text]), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported.
  
  
  CONCLUSIONS
  CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized patients.
authors.affiliation: Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198, USA. merupp@unmc.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rupp
authors.forename: R Jennifer
authors.initials: RJ
authors.lastname: Cavalieri
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lyden
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kucera
authors.forename: MaryAnn
authors.initials: M
authors.lastname: Martin
authors.forename: Teresa
authors.initials: T
authors.lastname: Fitzgerald
authors.forename: Kate
authors.initials: K
authors.lastname: Tyner
authors.forename: James R
authors.initials: JR
authors.lastname: Anderson
authors.forename: Trevor C
authors.initials: TC
authors.lastname: VanSchooneveld
mesh_terms: D000046:Academic Medical Centers; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D001494:Baths / Q000379:methods*; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification; D003015:Clostridium Infections / Q000517:prevention & control; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D006760:Hospitalization; D006801:Humans; D016012:Poisson Distribution
chemical_list: D000890:Anti-Infective Agents; C010882:chlorhexidine gluconate; D002710:Chlorhexidine