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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.

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/content/10.2807/1560-7917.ES.2016.21.46.30400
2016-11-17
2024-11-05
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.46.30400
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References

  1. European Antimicrobial Resistance Surveillance System (EARSS). EARSS annual report 2008. Bilthoven: EARSS; 2009. Available from: http://ecdc.europa.eu/en/healthtopics/antimicrobial-resistance-and-consumption/antimicrobial_resistance/publications-documents/Documents/2008_EARSS_Annual_Report.pdf
  2. Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol. 2008;29(11):996-1011.  https://doi.org/10.1086/591861  PMID: 18947320 
  3. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32(2):101-14.  https://doi.org/10.1086/657912  PMID: 21460463 
  4. Blot S, Vandewoude K, Hoste E, Colardyn F. Reappraisal of attributable mortality in critically ill patients with nosocomial bacteraemia involving Pseudomonas aeruginosa. J Hosp Infect. 2003;53(1):18-24.  https://doi.org/10.1053/jhin.2002.1329  PMID: 12495681 
  5. Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, De Waele JJ, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis. 2005;41(11):1591-8.  https://doi.org/10.1086/497833  PMID: 16267731 
  6. Edwards JR, Peterson KD, Mu Y, Banerjee S, Allen-Bridson K, Morrell G, et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control. 2009;37(10):783-805.  https://doi.org/10.1016/j.ajic.2009.10.001  PMID: 20004811 
  7. Vincent J-L, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323-9.  https://doi.org/10.1001/jama.2009.1754  PMID: 19952319 
  8. Verstraete E, Boelens J, De Coen K, Claeys G, Vogelaers D, Vanhaesebrouck P, et al. Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011): trends in incidence, pathogens, and mortality. Infect Control Hosp Epidemiol. 2014;35(5):511-8.  https://doi.org/10.1086/675836  PMID: 24709719 
  9. Blot K, Bergs J, Vogelaers D, Blot S, Vandijck D. Prevention of central line-associated bloodstream infections through quality improvement interventions: a systematic review and meta-analysis. Clin Infect Dis. 2014;59(1):96-105.  https://doi.org/10.1093/cid/ciu239  PMID: 24723276 
  10. Smith MJ. Catheter-related bloodstream infections in children. Am J Infect Control. 2008;36(10):S173.e1-3.
  11. Centers for Disease Control and Prevention (CDC). Reduction in central line-associated bloodstream infections among patients in intensive care units--Pennsylvania, April 2001-March 2005. MMWR Morb Mortal Wkly Rep. 2005;54(40):1013-6. PMID: 16224448 
  12. Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med. 2004;30(1):62-7.  https://doi.org/10.1007/s00134-003-2045-z  PMID: 14647886 
  13. O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2002;30(8):476-89.  https://doi.org/10.1067/mic.2002.129427  PMID: 12461511 
  14. Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet. 2000;355(9218):1864-8.  https://doi.org/10.1016/S0140-6736(00)02291-1  PMID: 10866442 
  15. Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet. 1991;338(8763):339-43.  https://doi.org/10.1016/0140-6736(91)90479-9  PMID: 1677698 
  16. Garland JS, Buck RK, Maloney P, Durkin DM, Toth-Lloyd S, Duffy M, et al. Comparison of 10% povidone-iodine and 0.5% chlorhexidine gluconate for the prevention of peripheral intravenous catheter colonization in neonates: a prospective trial. Pediatr Infect Dis J. 1995;14(6):510-6.  https://doi.org/10.1097/00006454-199506000-00008  PMID: 7667056 
  17. Vernon MO, Hayden MK, Trick WE, Hayes RA, Blom DW, Weinstein RA, et al. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Intern Med. 2006;166(3):306-12.  https://doi.org/10.1001/archinte.166.3.306  PMID: 16476870 
  18. Karki S, Cheng AC. Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. J Hosp Infect. 2012;82(2):71-84.  https://doi.org/10.1016/j.jhin.2012.07.005  PMID: 22889522 
  19. Derde LPG, Dautzenberg MJD, Bonten MJM. Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review. Intensive Care Med. 2012;38(6):931-9.  https://doi.org/10.1007/s00134-012-2542-z  PMID: 22527065 
  20. O’Horo JC, Silva GLM, Munoz-Price LS, Safdar N. The efficacy of daily bathing with chlorhexidine for reducing healthcare-associated bloodstream infections: a meta-analysis. Infect Control Hosp Epidemiol. 2012;33(3):257-67.  https://doi.org/10.1086/664496  PMID: 22314063 
  21. Higgins JPT, Altman DG, Sterne JAC, editors. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane handbook for systematic reviews of interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. London: The Cochrane Collaboration; 2011. Available from: www.handbook.cochrane.org
  22. Climo MW, Yokoe DS, Warren DK, Perl TM, Bolon M, Herwaldt LA, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med. 2013;368(6):533-42.  https://doi.org/10.1056/NEJMoa1113849  PMID: 23388005 
  23. Noto MJ, Domenico HJ, Byrne DW, Talbot T, Rice TW, Bernard GR, et al. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA. 2015;313(4):369-78.  https://doi.org/10.1001/jama.2014.18400  PMID: 25602496 
  24. Bleasdale SC, Trick WE, Gonzalez IM, Lyles RD, Hayden MK, Weinstein RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med. 2007;167(19):2073-9.  https://doi.org/10.1001/archinte.167.19.2073  PMID: 17954801 
  25. Milstone AM, Elward A, Song X, Zerr DM, Orscheln R, Speck K, et al. Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial. Lancet. 2013;381(9872):1099-106.  https://doi.org/10.1016/S0140-6736(12)61687-0  PMID: 23363666 
  26. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40.  https://doi.org/10.1016/0196-6553(88)90053-3  PMID: 2841893 
  27. Centers for Disease Control and Prevention (CDC). Central line–associated bloodstream infection (CLABSI) event protocol. Atlanta: CDC; 2014.
  28. Advani S, Reich NG, Sengupta A, Gosey L, Milstone AM. Central line-associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis. 2011;52(9):1108-15.  https://doi.org/10.1093/cid/cir145  PMID: 21454298 
  29. Niedner MF, Huskins WC, Colantuoni E, Muschelli J, Harris JM 2nd, Rice TB, et al. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infect Control Hosp Epidemiol. 2011;32(12):1200-8.  https://doi.org/10.1086/662621  PMID: 22080659 
  30. Kapadia BH, Johnson AJ, Issa K, Mont MA. Economic evaluation of chlorhexidine cloths on healthcare costs due to surgical site infections following total knee arthroplasty. J Arthroplasty. 2013;28(7):1061-5.  https://doi.org/10.1016/j.arth.2013.02.026  PMID: 23540539 
  31. Huang SS, Septimus E, Kleinman K, Moody J, Hickok J, Avery TR, et al. Targeted versus universal decolonization to prevent ICU infection. N Engl J Med. 2013;368(24):2255-65.  https://doi.org/10.1056/NEJMoa1207290  PMID: 23718152 
  32. Evans HL, Dellit TH, Chan J, Nathens AB, Maier RV, Cuschieri J. Effect of chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg. 2010;145(3):240-6.  https://doi.org/10.1001/archsurg.2010.5  PMID: 20231624 
  33. Ritz J, Pashnik B, Padula C, Simmons K. Effectiveness of 2 methods of chlorhexidine bathing. J Nurs Care Qual. 2012;27(2):171-5.  https://doi.org/10.1097/NCQ.0b013e3182398568  PMID: 22036832 
  34. Pittet D, Angus DC. Daily chlorhexidine bathing for critically ill patients: a note of caution. JAMA. 2015;313(4):365-6.  https://doi.org/10.1001/jama.2014.18482  PMID: 25603492 
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
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Elsa+Afonso&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Afonso Elsa</a>, <a href="/search?value1=Koen+Blot&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Blot Koen</a>, <a href="/search?value1=Stijn+Blot&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Blot Stijn</a></span>. 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. <a href="/content/ecdc">Euro Surveill.</a> 2016;21(46):pii=30400. <a href="https://doi.org/10.2807/1560-7917.ES.2016.21.46.30400" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2016.21.46.30400</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 04 Dec 2015;&nbsp;&nbsp; <span class="generated">Accepted</span>: 11 Jul 2016 </span> </p>
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