Infection Control & Hospital Epidemiology

Original Articles

Effect of Hospital-Wide Chlorhexidine Patient Bathing on Healthcare-Associated Infections

Mark E. Ruppa1a2 c1, R. Jennifer Cavalieria1, Elizabeth Lydena3, Jennifer Kuceraa1, MaryAnn Martina2, Teresa Fitzgeralda2, Kate Tynera2, James R. Andersona3 and Trevor C. VanSchoonevelda1a2

a1 Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska

a2 Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha, Nebraska

a3 Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska

Abstract

Background. Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs).

Design. Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts.

Setting. Academic medical center.

Patients. All patients except neonates and infants.

Intervention and Measurements. CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured.

Results. Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%, P< .001). A significant decrease in infections due to Clostridium difficile was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57–0.89; P = .003) for 3-days-per-week CHG bathing and 0.41 (95% CI, 0.29–0.59; P < .001) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38–2.53; P =< .001), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported.

Conclusions. CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized patients.

(Received March 19 2012)

(Accepted June 25 2012)

Correspondence

c1 984031 Nebraska Medical Center, Omaha, NE 68198 (merupp@unmc.edu)