Non-rinse CHG application significantly reduces the risk of CLABSI, SSI and colonization

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Intravenous literature: Karki, S. and Cheng, A.C. (2012) Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. The Journal of Hospital Infection. Aug 10. [Epub ahead of print].

Abstract:

BACKGROUND: The topical use of chlorhexidine gluconate (CHG) is intended to reduce bacterial density on patients’ skin.

AIM: To assess the impact of body bath or skin cleansing with CHG-impregnated or CHG-saturated washcloths in preventing healthcare-associated infections and colonization.

METHODS: This systematic review included published randomized controlled trials, cross-over trials, cohort studies and before-and-after studies. Studies were included if they compared the use of CHG in washcloths with any of the following; soap and water bathing, routine advice, no intervention.

FINDINGS: Sixteen published studies and four conference abstracts were included for systematic review. Nine studies reported the impact of CHG on incidence of central-line-associated bloodstream infection (CLABSI); the incidence rate ratio (IRR) was 0.43 [95% confidence interval (CI): 0.26-0.71]. Five studies assessed the impact of CHG washcloths on incidence of surgical site infection (SSI); the RR was 0.29 (95% CI: 0.17-0.49). Four studies reported the impact on vancomycin-resistant enterococci (VRE) colonization; the IRR was 0.43 (95% CI: 0.32-0.59). Three studies reported the impact on meticillin-resistant Staphylococcus aureus (MRSA) colonization rate; the IRR was 0.48 (95% CI: 0.24-0.95). Six studies reported the impact on VRE infection; the IRR was 0.90 (95% CI: 0.42-1.93). Six studies reported the impact on MRSA infection; the IRR was 0.82 (95% CI: 0.51-1.30). There was no reduction in acinetobacter infection rates in the three studies where this was reported.

CONCLUSION: These results suggest that the use of non-rinse CHG application significantly reduces the risk of CLABSI, SSI and colonization with VRE or MRSA, but not infection.

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