Daily skin cleansing with chlorhexidine did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit

Abstract

Purpose: Cleansing the skin of intensive care unit (ICU) patients daily with chlorhexidine gluconate (CHG) has been associated with beneficial effects, including a reduction in central-line-associated bacteremias (CLABSIs). Most studies have been done in medical ICUs. In this study, we evaluated the effectiveness of daily chlorhexidine skin cleansing on CLABSI rates in a surgical ICU. Methods: In Fall 2005, the 30-bed surgical ICU at Rush University Medical Center discontinued daily soap-and-water bathing of patients and substituted skin cleansing with no-rinse, 2% CHG-impregnated cloths. This change was made without research investigator input or oversight. Using administrative, microbiological and infection control practitioner databases, we compared rates of CLABSIs and blood culture contamination during soap-and-water bathing (September 2004-October 2005) and CHG cleansing (November 2005-October 2006) periods. Rates of other nosocomial infections that were not expected to be affected by CHG bathing (secondary bacteremia, Clostridium difficile-associated diarrhea, ventilator-associated pneumonia, urinary tract infection) were included as control variables. Results: There was no significant difference in the CLABSI rate between soap-and-water and CHG bathing periods (3.81/1,000 central line days vs. 4.6/1,000 central line days; p = 0.57). Blood culture contamination declined during CHG bathing (5.97/1,000 to 2.41/1,000 patient days; p = 0.003). Rates of other nosocomial infections did not change significantly. Conclusions: In this real-world effectiveness trial, daily cleansing of surgical ICU patients' skin with CHG had no effect on CLABSI rates, but was associated with half the rate of blood culture contamination. Controlled trials in surgical ICUs are needed to determine whether CHG bathing can prevent infections in this setting. © 2010 Copyright jointly held by Springer and ESICM.