title: Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: a systematic review and meta-analysis of randomised crossover trials.
abstract: We assessed the impact of 2% daily patient bathing with chlorhexidine gluconate (CHG) washcloths on the incidence of hospital-acquired (HA) and central line-associated (CLA) bloodstream infections (BSI) in intensive care units (ICUs). We searched randomised studies in Medline, EMBASE, Cochrane Library (CENTRAL) and Web of Science databases up to April 2015. Primary outcomes were total HABSI, central line, and non-central line-associated BSI rates per patient-days. Secondary outcomes included Gram-negative and Gram-positive BSI rates and adverse events. Four randomised crossover trials involved 25 ICUs and 22,850 patients. Meta-analysis identified a total HABSI rate reduction (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.60-0.90; p = 0.002) with moderate heterogeneity (I2= 36%). Subgroup analysis identified significantly stronger rate reductions (p = 0.01) for CLABSI (OR: 0.50; 95% CI: 0.35-0.71; p < 0.001) than other HABSI (OR: 0.82; 95% CI: 0.70-0.97; p = 0.02) with low heterogeneity (I2= 0%). This effect was evident in the Gram-positive subgroup (OR: 0.55; 95% CI: 0.31-0.99; p = 0.05), but became non-significant after removal of a high-risk-of-bias study. Sensitivity analysis revealed that the intervention effect remained significant for total and central line-associated HABSI. We suggest that use of CHG washcloths prevents HABSI and CLABSI in ICUs, possibly due to the reduction in Gram-positive skin commensals.
authors.affiliation: Neonatal Intensive Care Unit, Cambridge University Hospital, Cambridge, United Kingdom.|These authors contributed equally to the manuscript.
authors.forename: Elsa
authors.initials: E
authors.lastname: Afonso
authors.affiliation: These authors contributed equally to the manuscript.|Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Blot
authors.affiliation: Department of General Internal Medicine, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.|Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia.
authors.forename: Stijn
authors.initials: S
authors.lastname: Blot
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D001494:Baths / Q000379:methods*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D018592:Cross-Over Studies; D004202:Disinfectants / Q000008:administration & dosage*; D006801:Humans; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic
chemical_list: D000891:Anti-Infective Agents, Local; D004202:Disinfectants; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: Intensive Care; healthcare-associated infections; hygiene; infection control; policy; prevention