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Volume 3 Supplement 1

ESICM LIVES 2015

Prevention of hospital-acquired and central line-associated bloodstream infections in the intensive care unit through chlorhexidine gluconate washcloth bathing: a systematic review and meta-analysis

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Background

Bloodstream Infection and Central Line-Associated Bloodstream Infection (BSI/CLABSI) in Intensive Care Units (ICUs) are associated with clinical and economic burden. Chlorhexidine gluconate body washing with washcloths (CHG-WC) has been described as potentially effective towards reducing the spread of infection. Current systematized evidence has not fully ascertained the impact of CHG-WC in bacteremia within the ICU. We have systematically assessed the evidence on the effectiveness of CHG-WC in reducing total HABSI/CLABSI in the ICU.

Objectives

To systematically review the effect of CHG-WC on total HABSI/CLABSI risk in the ICU.

Methods

Medline, EMBASE, Cochrane library (CENTRAL) and Web of science databases were searched using variations of key terms Chlorhexidine washcloths, ICU, BSI and CLABSI. Eligible trials implemented CHG-WC in ICUs using a randomized crossover study design and reported total HABSI and CLABSI rates per patient days. Methodological quality of studies was assessed using Cochrane Risk of Bias assessment tool. Random effects meta-analysis calculated odds ratios (OR) and 95% confidence intervals (CI) for total HABSI and CLABSI rates between control (regular washcloth bathing) and treatment groups (CHG-WC). Results of 4 eligible studies were included in the final analysis.

Results

All 4 eligible studies were large randomized control trials encompassing 706 events in 22850 patients from 15 adult and 10 paediatric ICUs. Three studies describe a reduction in total HABSI/CLABSI on patients who received CHG-WC bathing. In one study this reduction is not significant.

Conclusions

Current data suggests that the use of CHG-WC may be associated with an overall risk reduction of total HABSI and CLABSI, in adult/paediatric ICUs. However, conflicting data remains from the most recent randomized controlled trial, and even though this can be related to discrepancies in study design and outcome reporting, more trials are needed in order to ascertain the usefulness of CHG-WC bathing in the ICU.

Figure 1
figure1

Overall impact of CHG-WC in HABS/CLABSI.

Figure 2
figure2

Subgroup analysis.

References

  1. 1.

    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): 533-542. 10.1056/NEJMoa1113849.

  2. 2.

    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): 2073-2079. 10.1001/archinte.167.19.2073.

  3. 3.

    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): 1099-1106. 10.1016/S0140-6736(12)61687-0.

  4. 4.

    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): 369-378. 10.1001/jama.2014.18400.

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Author information

Correspondence to EP Afonso.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Keywords

  • Intensive Care Unit
  • Eligible Study
  • Bloodstream Infection
  • Chlorhexidine
  • Bias Assessment