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.
Highlights
Hospital-acquired bloodstream infections (HABSI) and the subgroup of central line-associated bloodstream infections (CLABSI) are associated with substantial morbidity, mortality, and healthcare costs in adults and children [1,2,3,4,5], with higher infection rates among hospitalised children [6]
Data from the EPIC II study have shown that of all nosocomial infections in the intensive care unit (ICU), 15% were bloodstream infections (BSI), with CLABSI accounting for 4.7% [7,8]
The intervention effect per number of patients was comparable for total HABSI (OR = 0.73; 95% confidence interval (CI): 0.58– 0.91; p = 0.006), CLABSI (OR = 0.50; 95% CI: 0.35–0.71; p = 0.0001) and non-central line HABSI (OR = 0.82; 95% CI: 0.68–0.97; p = 0.02)
Summary
Hospital-acquired bloodstream infections (HABSI) and the subgroup of central line-associated bloodstream infections (CLABSI) are associated with substantial morbidity, mortality, and healthcare costs in adults and children [1,2,3,4,5], with higher infection rates among hospitalised children [6]. Data from the EPIC II study have shown that of all nosocomial infections in the intensive care unit (ICU), 15% were bloodstream infections (BSI), with CLABSI accounting for 4.7% [7,8]. CLABSI results from catheter tip contamination by commensal skin flora at time of device insertion and later from microorganisms migrating from skin to the catheter tip or lumen [12]. The risk of CLABSI can be reduced by antiseptic skin preparation immediately before catheter insertion and by maintaining asepsis at insertion site and catheter access points [13]. As a substantial proportion of primary BSI originate from vascular access devices, these infections decrease following preventive interventions targeting CLABSI [14]
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