Abstract:
Objective: Daily chlorhexidine bathing has been associated with a reduction of central line-associated bloodstream infections (CLABSI). In the setting of an already established CLABSI surveillance system and an implemented CLABSI prevention bundle we analyzed the effect of daily chlorhexidine bathing in ICU patients on CLABSI incidence and its causative pathogens.
Methods: Before-and-after study in intensive care units (ICU) at a tertiary care centre in Switzerland. Prospective surveillance of CLABSI and their aetiologies was established. The intervention consisted of daily chlorhexidine bathing of ICU patients with a central venous catheter. A baseline period of 19 months was followed by an intervention period of 9 months.
Results: A total of 5008 patients were included. In the baseline period a mean CLABSI rate of 2.45/1000 catheter days (95% confidence interval (95%CI) 1.93-3.07) was observed, followed by 1.00/1000 catheter days (95%CI 0.55-1.67; P<0.001) in the intervention period. Introduction of chlorhexidine bathing was independently associated with a reduced risk of CLABSI (adjusted odds ratio 0.47, 95%CI 0.26-0.84, P=0.011). We did not observe a significant change in etiology except for an increase of Serratia marcescens in the intervention period.
Conclusion: Introduction of daily chlorhexidine bathing resulted in a decline of CLABSI incidence on ICUs. Starting from a baseline CLABSI rate that can be considered standard in a high-income setting and several measures for CLABSI prevention implemented, chlorhexidine bathing proved helpful for a further reduction.
Reference:
Scheier T, Saleschus D, Dunic M, Fröhlich MR, Schüpbach R, Falk C, Sax H, Kuster SP, Schreiber PW. Implementation of daily chlorhexidine bathing in intensive care units for reduction of central line-associated bloodstream infections. J Hosp Infect. 2021 Jan 19:S0195-6701(21)00024-4. doi: 10.1016/j.jhin.2021.01.007. Epub ahead of print. PMID: 33482298.