title: A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units.
abstract: OBJECTIVE To determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). DESIGN Interrupted time series analysis. SETTING The study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013. PARTICIPANTS All ICU patients at study hospitals during the study period. METHODS Of the 33 hospitals, 17 hospitals implemented CHG bathing during the study period, and 16 hospitals that did not perform CHG bathing served as controls. Primary pre-specified outcomes included ICU central-line-associated bloodstream infections (CLABSIs), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs). MRSA and VRE HAIs were also evaluated. RESULTS Chlorhexidine gluconate (CHG) bathing was associated with a significant downward trend in incidence rates of ICU CLABSI (incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.93-0.99), ICU primary BSI (IRR, 0.96; 95% CI, 0.94-0.99), VRE CLABSIs (IRR, 0.97; 95% CI, 0.97-0.98), and all combined VRE infections (IRR, 0.96; 95% CI, 0.93-1.00). No significant trend in MRSA infection incidence rates was identified prior to or following the implementation of CHG bathing. CONCLUSIONS In this multicenter, real-world analysis of the impact of CHG bathing, hospitals that implemented CHG bathing attained a decrease in ICU CLABSIs, ICU primary BSIs, and VRE CLABSIs. CHG bathing did not affect rates of specific or overall infections due to MRSA. Our findings support daily CHG bathing of ICU patients. Infect Control Hosp Epidemiol 2016;37:791-797.
authors: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors: Kristen V
authors: KV
authors: Dicks
authors: 3Network Dynamics and Simulation Science Lab,Virginia Bioinformatics Institute,Virginia Tech,Blacksburg,Virginia.
authors: Eric
authors: E
authors: Lofgren
authors: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors: Sarah S
authors: SS
authors: Lewis
authors: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors: Rebekah W
authors: RW
authors: Moehring
authors: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors: Daniel J
authors: DJ
authors: Sexton
authors: 1Department of Medicine,Division of Infectious Diseases,Duke University Medical Center,Durham,North Carolina.
authors: Deverick J
authors: DJ
authors: Anderson
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D006764:Hospitals, Community / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D065186:Interrupted Time Series Analysis; D055624:Methicillin-Resistant Staphylococcus aureus; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology / Q000517:prevention & control; D013203:Staphylococcal Infections / Q000517:prevention & control; D065507:Vancomycin-Resistant Enterococci
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine