title: The Effect of Chlorhexidine Bathing on Rates of Nosocomial Infections Among the Critically Ill Population: An Analysis of Current Clinical Research and Recommendations for Practice.
abstract: BACKGROUND
  This literature review examined the current research of evidence-based standards to evaluate the effectiveness of daily bathing with 2% chlorhexidine gluconate (CHG; manufactured by Sage Products Inc) compared with traditional non-antimicrobial bathing on reducing the incidence of nosocomial infections in the critically ill population.
  
  
  OBJECTIVE
  The objective of this article is 3-fold: first, to provide a background on the increased susceptibility to pathogens that have become endemic in many intensive care units; second, to challenge health care providers to question current practice and consider additional ways to ensure safety and better outcomes in the critically ill population; and third, to provide health care providers with clinical evidence to avoid infection control failures.
  
  
  METHODS
  To determine whether published standards for daily patient bathing exist, a search was conducted of bibliographic databases for articles published within the last 5 years (2010-2015). Ultimately, 3 large multicenter cluster randomized controlled studies were chosen to compare the outcomes of daily bathing with 2% CHG cloths with those of daily bathing with non-antimicrobial cloths.
  
  
  RESULTS
  The side-by-side comparison of the studies revealed similar outcomes, but with variations in study design. Climo et al (2013) and Milestone et al (2013) recommended the implementation of daily bathing with 2% CHG washcloths as a strategy to decrease nosocomial infections in the critically ill population. Huang et al (2013) recommended universal decolonization as the most effective method to decrease nosocomial infections.
  
  
  CONCLUSIONS
  The analysis of the 3 primary studies revealed similar findings that support the recommendation for the implementation of daily bathing with 2% CHG in the critically ill population. Further research will inform clinicians on the susceptibility of bacteria to CHG and the probability of creating microbial resistance.
authors.affiliation: Kimberly Raines, AGACNP-BC, MSN, BSN, RN, CCRN, is a medical critical care fellow at the Carolina Healthcare System, Charlotte, North Carolina, and School of Nursing, University of Pennsylvania, Philadelphia. Kelsey Rosen, AGACNP-BC, MSN, BSN, RN, is a trauma surgery and critical care medicine fellow at the George Washington University Hospital, and School of Nursing, University of Pennsylvania, Philadelphia.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Raines
authors.forename: Kelsey
authors.initials: K
authors.lastname: Rosen
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001494:Baths; D002710:Chlorhexidine / Q000627:therapeutic use*; D016638:Critical Illness; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine