Effect of daily chlorhexidine bathing on hospital-acquired infection

Michael W. Climo, Deborah S. Yokoe, David K. Warren, Trish M. Perl, Maureen Bolon, Loreen A. Herwaldt, Robert A. Weinstein, Kent A. Sepkowitz, John A. Jernigan, Kakotan Sanogo, Edward S. Wong

Research output: Contribution to journalArticle

366 Citations (Scopus)

Abstract

BACKGROUND: Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs). METHODS: We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine - impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis. RESULTS: A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period. CONCLUSIONS: Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired blood-stream infections.

Original languageEnglish (US)
Pages (from-to)533-542
Number of pages10
JournalNew England Journal of Medicine
Volume368
Issue number6
DOIs
StatePublished - Feb 7 2013

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Chlorhexidine
Cross Infection
Infection
Incidence
Critical Care
Bone Marrow Transplantation
Cross-Over Studies
Observational Studies
Regression Analysis
Skin

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Climo, M. W., Yokoe, D. S., Warren, D. K., Perl, T. M., Bolon, M., Herwaldt, L. A., ... Wong, E. S. (2013). Effect of daily chlorhexidine bathing on hospital-acquired infection. New England Journal of Medicine, 368(6), 533-542. https://doi.org/10.1056/NEJMoa1113849

Effect of daily chlorhexidine bathing on hospital-acquired infection. / Climo, Michael W.; Yokoe, Deborah S.; Warren, David K.; Perl, Trish M.; Bolon, Maureen; Herwaldt, Loreen A.; Weinstein, Robert A.; Sepkowitz, Kent A.; Jernigan, John A.; Sanogo, Kakotan; Wong, Edward S.

In: New England Journal of Medicine, Vol. 368, No. 6, 07.02.2013, p. 533-542.

Research output: Contribution to journalArticle

Climo, MW, Yokoe, DS, Warren, DK, Perl, TM, Bolon, M, Herwaldt, LA, Weinstein, RA, Sepkowitz, KA, Jernigan, JA, Sanogo, K & Wong, ES 2013, 'Effect of daily chlorhexidine bathing on hospital-acquired infection', New England Journal of Medicine, vol. 368, no. 6, pp. 533-542. https://doi.org/10.1056/NEJMoa1113849
Climo, Michael W. ; Yokoe, Deborah S. ; Warren, David K. ; Perl, Trish M. ; Bolon, Maureen ; Herwaldt, Loreen A. ; Weinstein, Robert A. ; Sepkowitz, Kent A. ; Jernigan, John A. ; Sanogo, Kakotan ; Wong, Edward S. / Effect of daily chlorhexidine bathing on hospital-acquired infection. In: New England Journal of Medicine. 2013 ; Vol. 368, No. 6. pp. 533-542.
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abstract = "BACKGROUND: Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs). METHODS: We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2{\%} chlorhexidine - impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis. RESULTS: A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.03), the equivalent of a 23{\%} lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.007), a 28{\%} lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period. CONCLUSIONS: Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired blood-stream infections.",
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AU - Climo, Michael W.

AU - Yokoe, Deborah S.

AU - Warren, David K.

AU - Perl, Trish M.

AU - Bolon, Maureen

AU - Herwaldt, Loreen A.

AU - Weinstein, Robert A.

AU - Sepkowitz, Kent A.

AU - Jernigan, John A.

AU - Sanogo, Kakotan

AU - Wong, Edward S.

PY - 2013/2/7

Y1 - 2013/2/7

N2 - BACKGROUND: Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs). METHODS: We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine - impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis. RESULTS: A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period. CONCLUSIONS: Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired blood-stream infections.

AB - BACKGROUND: Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs). METHODS: We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine - impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis. RESULTS: A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period. CONCLUSIONS: Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired blood-stream infections.

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