The efficacy of daily chlorhexidine bathing for preventing healthcare-associated infections in adult intensive care units

Korean J Intern Med. 2016 Nov;31(6):1159-1170. doi: 10.3904/kjim.2015.240. Epub 2016 Apr 6.

Abstract

Background/aims: Healthcare-associated infections (HAIs) in critically ill patients with prolonged length of hospital stay and increased medical costs. The aim of this study is to assess whether daily chlorhexidine gluconate (CHG) bathing will significantly reduce the rates of HAIs in adult intensive care units (ICUs).

Methods: PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were systematically searched until December 31, 2014 to identify relevant studies. Two authors independently reviewed and extracted data from included studies. All data was analyzed by Review Manager version 5.3.

Results: Fifteen studies including three randomized controlled trials and 12 quasi-experimental studies were available in this study. The outcomes showed that daily CHG bathing were associated with significant reduction in the rates of primary outcomes: catheter-related bloodstream infection (risk ratio [RR], 0.44; 95% confidence interval [CI], 0.32 to 0.63; p < 0.00001), catheter-associated urinary tract infection (RR, 0.68; 95% CI, 0.52 to 0.88; p = 0.004), ventilator-associated pneumonia (RR, 0.73; 95% CI, 0.57 to 0.93; p = 0.01), acquisition of methicillin-resistant Staphylococcus aureus (RR, 0.78; 95% CI, 0.68 to 0.91; p = 0.001) and vancomycin-resistant Enterococcus (RR, 0.56; 95% CI, 0.31 to 0.99; p = 0.05).

Conclusions: Our study suggests that the use of daily CHG bathing can significantly prevent HAIs in ICUs. However, more well-designed studies are needed to confirm these findings.

Keywords: Bathing; Chlorhexidine gluconate; Infection; Intensive care units.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Anti-Infective Agents, Local / therapeutic use*
  • Baths*
  • Catheter-Related Infections / diagnosis
  • Catheter-Related Infections / microbiology
  • Catheter-Related Infections / prevention & control*
  • Catheter-Related Infections / transmission
  • Chi-Square Distribution
  • Chlorhexidine / analogs & derivatives*
  • Chlorhexidine / therapeutic use
  • Critical Care / methods*
  • Cross Infection / diagnosis
  • Cross Infection / microbiology
  • Cross Infection / prevention & control*
  • Cross Infection / transmission
  • Humans
  • Infection Control / methods*
  • Intensive Care Units
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Odds Ratio
  • Respiration, Artificial / adverse effects
  • Respiratory Tract Infections / diagnosis
  • Respiratory Tract Infections / microbiology
  • Respiratory Tract Infections / prevention & control*
  • Respiratory Tract Infections / transmission
  • Risk Factors
  • Treatment Outcome
  • Urinary Catheterization / adverse effects
  • Urinary Tract Infections / diagnosis
  • Urinary Tract Infections / microbiology
  • Urinary Tract Infections / prevention & control*
  • Urinary Tract Infections / transmission
  • Vancomycin Resistance
  • Vancomycin-Resistant Enterococci / drug effects
  • Vancomycin-Resistant Enterococci / isolation & purification

Substances

  • Anti-Infective Agents, Local
  • chlorhexidine gluconate
  • Chlorhexidine