Chlorhexidine bathing protects vulnerable hospital patients

By Eleanor McDermid, Senior medwireNews Reporter

Bathing hospital patients with chlorhexidine-impregnated washcloths reduces the risk for them acquiring multidrug-resistant organisms and developing bloodsteam infections, show study findings.

The multicenter cluster-randomized crossover trial focused on patients at high risk for infections, consisting of a total of 7727 patients in intensive care units or bone marrow transplantation units. The researchers found that the benefits of using chlorhexidine washcloths increased the longer patients stayed on the units.

"Daily bathing with chlorhexidine-impregnated washcloths is a strategy that is relatively straightforward to implement and sustain because it does not require a substantial change from patient-bathing practices that are currently routine," say lead researcher Michael Climo (Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia, USA) and team.

The study lasted for 12 months. There were 165 new acquisitions of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococcus (VRE) during the 6-month control phase when nonantimicrobial washcloths were used, compared with 127 during the chlorhexidine-washcloth phase. This amounted to a significant 23% reduction for all infections, a significant 25% reduction for VRE acquisition and a nonsignificant 19% reduction for MRSA acquisition.

Patients developed 165 hospital-acquired bloodstream infections during the control period, compared with 119 during the intervention period. This equated to a significant 28% reduction overall, and the benefits increased the longer patients stayed on the unit, with the reduction increasing to 31% for those who stayed for more than 7 days and 49% for those who stayed for more than 14 days.

"Our study also had some unanticipated findings," say Climo et al in The New England Journal of Medicine. They found that use of chlorhexidine washcloths significantly reduced the incidence of central-catheter-associated bloodstream infections, in particular those caused by fungi, which fell from 0.77 to 0.07 cases per 1000 catheter-days.

"If our results are confirmed, topical use of chlorhexidine could be added to strategies to prevent fungal infections," writes the team.

No patient developed a skin reaction to chlorhexidine, and there was no evidence for emerging chlorhexidine-resistant strains of MRSA or VRE during the study.

"Concern regarding increased resistance of nosocomial bacteria to biocides and disinfectants like chlorhexidine has tempered enthusiasm for wider adoption of their use in hospitals for skin antisepsis," say the researchers. "The potential for the emergence of resistance to chlorhexidine remains a substantial concern and should be monitored over time."

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