title: Daily bathing with chlorhexidine-based soap and the prevention of Staphylococcus aureus transmission and infection.
abstract: OBJECTIVE
  Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive care unit (ICU)-acquired S. aureus infection among ICU patients.
  
  
  METHODS
  Prospective pre-post-intervention study with control unit.
  
  
  METHODS
  A 1,250-bed tertiary care teaching hospital.
  
  
  METHODS
  Medical and surgical ICU patients.
  
  
  METHODS
  Active surveillance for MRSA colonization was performed in both ICUs. In June 2005, a chlorhexidine bathing protocol was implemented in the surgical ICU. Changes in S. aureus transmission and infection rate before and after implementation were analyzed using time-series methodology.
  
  
  RESULTS
  The intervention unit had a 20.68% decrease in MRSA acquisition after institution of the bathing protocol (12.64 cases per 1,000 patient-days at risk before the intervention vs 10.03 cases per 1,000 patient-days at risk after the intervention; β, -2.62 [95% confidence interval (CI), -5.19 to -0.04]; P = .046). There was no significant change in MRSA acquisition in the control ICU during the study period (10.97 cases per 1,000 patient-days at risk before June 2005 vs 11.33 cases per 1,000 patient-days at risk after June 2005; β, -11.10 [95% CI, -37.40 to 15.19]; P = .40). There was a 20.77% decrease in all S. aureus (including MRSA) acquisition in the intervention ICU from 2002 through 2007 (19.73 cases per 1,000 patient-days at risk before the intervention to 15.63 cases per 1,000 patient-days at risk after the intervention [95% CI, -7.25 to -0.95]; P = .012)]. The incidence of ICU-acquired MRSA infections decreased by 41.37% in the intervention ICU (1.96 infections per 1,000 patient-days at risk before the intervention vs 1.15 infections per 1,000 patient-days at risk after the intervention; P = .001).
  
  
  CONCLUSIONS
  Institution of daily chlorhexidine bathing in an ICU resulted in a decrease in the transmission of S. aureus, including MRSA. These data support the use of routine daily chlorhexidine baths to decrease rates of S. aureus transmission and infection.
authors: Washington University School of Medicine, St. Louis, Missouri.
authors: Melissa A
authors: MA
authors: Viray
authors: James C
authors: JC
authors: Morley
authors: Craig M
authors: CM
authors: Coopersmith
authors: Marin H
authors: MH
authors: Kollef
authors: Victoria J
authors: VJ
authors: Fraser
authors: David K
authors: DK
authors: Warren
mesh_terms: D002710:Chlorhexidine; D003428:Cross Infection / Q000517:prevention & control*; D004202:Disinfectants; D004203:Disinfection / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D055624:Methicillin-Resistant Staphylococcus aureus; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000517:prevention & control*
chemical_list: D004202:Disinfectants; D002710:Chlorhexidine