title: Effect of daily chlorhexidine bathing on hospital-acquired infection.
abstract: BACKGROUND
  Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs).
  
  
  METHODS
  We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine-impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis.
  
  
  RESULTS
  A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period.
  
  
  CONCLUSIONS
  Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired bloodstream infections. (Funded by the Centers for Disease Control and Prevention and Sage Products; ClinicalTrials.gov number, NCT00502476.).
authors: Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA 23249, USA. michael.climo@va.gov
authors: Michael W
authors: MW
authors: Climo
authors: Deborah S
authors: DS
authors: Yokoe
authors: David K
authors: DK
authors: Warren
authors: Trish M
authors: TM
authors: Perl
authors: Maureen
authors: M
authors: Bolon
authors: Loreen A
authors: LA
authors: Herwaldt
authors: Robert A
authors: RA
authors: Weinstein
authors: Kent A
authors: KA
authors: Sepkowitz
authors: John A
authors: JA
authors: Jernigan
authors: Kakotan
authors: K
authors: Sanogo
authors: Edward S
authors: ES
authors: Wong
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D001494:Baths; D002710:Chlorhexidine / Q000627:therapeutic use*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D018592:Cross-Over Studies; D024901:Drug Resistance, Multiple, Bacterial; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D016016:Proportional Hazards Models; D013203:Staphylococcal Infections / Q000517:prevention & control; D020713:Vancomycin Resistance
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine
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