title: Efficacy of chlorhexidine bathing for reducing healthcare associated bloodstream infections: a meta-analysis.
abstract: BACKGROUND
  We performed a meta-analysis of randomized controlled trials (RCTs) to determine if daily bathing with chlorhexidine decreased hospital-acquired BSIs in critically ill patients.
  
  
  METHODS
  We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify randomized controlled trials that compared daily bathing with chlorhexidine and a control in critically ill patients.
  
  
  RESULTS
  This meta-analysis included five RCTs. The overall incidence of measured hospital-acquired BSIs was significantly lower in the chlorhexidine group compared to the controls 0.69 (95 % CI 0.55-0.85; P < 0.001; I (2) = 57.7 %). Gram-positive-induced (RR = 0.49, 95 % CI 0.41-0.58; P = 0.000; I (2) = 0.0 %) bacteremias were significantly less common in the chlorhexidine group. The incidence of MRSA bacteremias (RR 0.63; 95 % CI 0.44-0.91; P = 0.006; I (2) = 30.3 %) was significantly lower among patients who received mupirocin in addition to chlorhexidine bathing than among those who did not routinely receive mupirocin.
  
  
  CONCLUSIONS
  Daily bathing with chlorhexidine may be effective to reduce the incidence of hospital-acquired BSIs. However, chlorhexidine bathing alone may be of limited utility in reduction of MRSA bacteremia; intranasal mupirocin may also be required. This meta-analysis has several limitations. Future large-scale international multicenter studies are needed.
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea. letact@hanmail.net.
authors.forename: Eun Young
authors.initials: EY
authors.lastname: Choi
authors.affiliation: Office of Health Technology Evaluation, National Evidence-Based Healthcare Collaborating Agency, Seoul, Republic of Korea. pda124@neca.re.kr.
authors.forename: Dong-Ah
authors.initials: DA
authors.lastname: Park
authors.affiliation: Institute for Evidence-based Medicine, The Korean Branch of Australasian Cochrane Center, Seoul, Republic of Korea. moole02@naver.com.|Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea. moole02@naver.com.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Critical Care Medicine in Samsung Medical Center, Sungkyunkwan University School of Medicine, # 50, Irwon-Dong, Gangnam-gu, Seoul, Republic of Korea. drjinnie@me.com.
authors.forename: Jinkyeong
authors.initials: J
authors.lastname: Park
keywords: Chlorhexidine; Critically ill; MRSA; Meta-analysis; Mupirocin