title: Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand.
abstract: OBJECTIVE
  To determine the effectiveness of daily bathing with 2% chlorhexidine-impregnated washcloths in preventing multidrug-resistant (MDR) gram-positive bacterial colonization and bloodstream infection.
  
  
  METHODS
  A randomized, open-label controlled trial was conducted in 4 medical intensive care units (ICUs) in Thailand from December 2013 to January 2015. Patients were randomized to receive cleansing with non-antimicrobial soap (control group) or 2% chlorhexidine-impregnated washcloths used to wipe the patient's body once daily (chlorhexidine group). Swabs were taken from nares, axilla, antecubital, groin, and perianal areas on admission and on day 3, 5, 7, and 14. The 5 outcomes were (1) favorable events ( all samples negative throughout ICU admission, or initially positive samples with subsequent negative samples); (2) MDR bacteria colonization-free time; (3) hospital-acquired infection; (4) length of ICU and hospital stay; (5) adverse skin reactions.
  
  
  RESULTS
  A total of 481 patients were randomly assigned to the control group (241) or the chlorhexidine group (240). Favorable events at day 14 were observed in 34.8% of patients in the control group and 28.6% in the chlorhexidine group (P=.79). Median MDR bacteria colonization-free times were 5 days in both groups. The incidence rate of hospital-acquired infection and the length of the ICU and hospital stay did not differ significantly between groups. The incidence of adverse skin reactions in the chlorhexidine group was 2.5%.
  
  
  CONCLUSIONS
  The effectiveness of 2% chlorhexidine-impregnated washcloths for the prevention of MDR gram-negative bacteria colonization and hospital-acquired infection in adult patients in ICU was not proven. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01989416.
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Adhiratha
authors.initials: A
authors.lastname: Boonyasiri
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Peerapat
authors.initials: P
authors.lastname: Thaisiam
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Chairat
authors.initials: C
authors.lastname: Permpikul
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Tepnimitr
authors.initials: T
authors.lastname: Judaeng
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Bordeesuda
authors.initials: B
authors.lastname: Suiwongsa
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Napaporn
authors.initials: N
authors.lastname: Apiradeewajeset
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Teerawan
authors.initials: T
authors.lastname: Fakthongphan
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Sunun
authors.initials: S
authors.lastname: Suddee
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Wandee
authors.initials: W
authors.lastname: Laoagtipparos
authors.affiliation: Faculty of Medicine Siriraj Hospital,Mahidol University,Bangkok,Thailand.
authors.forename: Visanu
authors.initials: V
authors.lastname: Thamlikitkul
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001494:Baths; D002710:Chlorhexidine / Q000008:administration & dosage*; D003428:Cross Infection / Q000517:prevention & control*; D004202:Disinfectants / Q000008:administration & dosage*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012915:Soaps; D013785:Thailand; D055815:Young Adult
chemical_list: D004202:Disinfectants; D012915:Soaps; D002710:Chlorhexidine