The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections

Results of a quasi-experimental multicenter trial

Michael W. Climo, Kent A. Sepkowitz, Gianna Zuccotti, Victoria J. Fraser, David K. Warren, Trish M. Perl, Kathleen Speck, John A. Jernigan, Jaime R. Robles, Edward S. Wong

Research output: Contribution to journalReview article

221 Citations (Scopus)

Abstract

Objective: Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patients. Design, setting, and patients: Six ICUs at four academic centers measured the incidence of MRSA and VRE colonization and BSI during a period of bathing with routine soap for 6 months and then compared results with a 6-month period where all admitted patients received daily bathing with a chlorhexidine solution. Changes in incidence were evaluated by Poisson and segmented regression modeling. Interventions: Daily bathing with a chlorhexidine-containing solution. Measurements and main results: Acquisition of MRSA decreased 32% (5.04 vs. 3.44 cases/1000 patient days, p = 0.046) and acquisition of VREdecreased 50% (4.35 vs. 2.19 cases/1000 patient days, p = 0.008) following the introduction of daily chlorhexidine bathing. Segmented regression analysis demonstrated significant reductions in VRE bacteremia (p = 0.02) following the introduction of chlorhexidine bathing. VRE-colonized patients bathed with chlorhexidine had a lower risk of developing VRE bacteremia (relative risk 3.35; 95% confidence interval 1.13-9.87; p = 0.035), suggesting that reductions in the level of colonization led to the observed reductions in BSI. Conclusion: We conclude that daily chlorhexidine bathing among ICU patients may reduce the acquisition of MRSA and VRE. The approach is simple to implement and inexpensive and may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated BSI.

Original languageEnglish (US)
Pages (from-to)1858-1865
Number of pages8
JournalCritical Care Medicine
Volume37
Issue number6
DOIs
StatePublished - Jan 1 2009

Fingerprint

Chlorhexidine
Methicillin-Resistant Staphylococcus aureus
Cross Infection
Multicenter Studies
Intensive Care Units
Bacteremia
Incidence
Infection
Soaps
Vancomycin-Resistant Enterococci
Regression Analysis
Confidence Intervals
Morbidity
Mortality

Keywords

  • Bacteremia
  • Chlorhexidine
  • Enterococcus
  • Methicillin resistance
  • Staphylococcus aureus
  • Vancomycin resistance

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections : Results of a quasi-experimental multicenter trial. / Climo, Michael W.; Sepkowitz, Kent A.; Zuccotti, Gianna; Fraser, Victoria J.; Warren, David K.; Perl, Trish M.; Speck, Kathleen; Jernigan, John A.; Robles, Jaime R.; Wong, Edward S.

In: Critical Care Medicine, Vol. 37, No. 6, 01.01.2009, p. 1858-1865.

Research output: Contribution to journalReview article

Climo, Michael W. ; Sepkowitz, Kent A. ; Zuccotti, Gianna ; Fraser, Victoria J. ; Warren, David K. ; Perl, Trish M. ; Speck, Kathleen ; Jernigan, John A. ; Robles, Jaime R. ; Wong, Edward S. / The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections : Results of a quasi-experimental multicenter trial. In: Critical Care Medicine. 2009 ; Vol. 37, No. 6. pp. 1858-1865.
@article{1019aa71800f4c75b46caf7b62b5c608,
title = "The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections: Results of a quasi-experimental multicenter trial",
abstract = "Objective: Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patients. Design, setting, and patients: Six ICUs at four academic centers measured the incidence of MRSA and VRE colonization and BSI during a period of bathing with routine soap for 6 months and then compared results with a 6-month period where all admitted patients received daily bathing with a chlorhexidine solution. Changes in incidence were evaluated by Poisson and segmented regression modeling. Interventions: Daily bathing with a chlorhexidine-containing solution. Measurements and main results: Acquisition of MRSA decreased 32{\%} (5.04 vs. 3.44 cases/1000 patient days, p = 0.046) and acquisition of VREdecreased 50{\%} (4.35 vs. 2.19 cases/1000 patient days, p = 0.008) following the introduction of daily chlorhexidine bathing. Segmented regression analysis demonstrated significant reductions in VRE bacteremia (p = 0.02) following the introduction of chlorhexidine bathing. VRE-colonized patients bathed with chlorhexidine had a lower risk of developing VRE bacteremia (relative risk 3.35; 95{\%} confidence interval 1.13-9.87; p = 0.035), suggesting that reductions in the level of colonization led to the observed reductions in BSI. Conclusion: We conclude that daily chlorhexidine bathing among ICU patients may reduce the acquisition of MRSA and VRE. The approach is simple to implement and inexpensive and may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated BSI.",
keywords = "Bacteremia, Chlorhexidine, Enterococcus, Methicillin resistance, Staphylococcus aureus, Vancomycin resistance",
author = "Climo, {Michael W.} and Sepkowitz, {Kent A.} and Gianna Zuccotti and Fraser, {Victoria J.} and Warren, {David K.} and Perl, {Trish M.} and Kathleen Speck and Jernigan, {John A.} and Robles, {Jaime R.} and Wong, {Edward S.}",
year = "2009",
month = "1",
day = "1",
doi = "10.1097/CCM.0b013e31819ffe6d",
language = "English (US)",
volume = "37",
pages = "1858--1865",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - The effect of daily bathing with chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and healthcare-associated bloodstream infections

T2 - Results of a quasi-experimental multicenter trial

AU - Climo, Michael W.

AU - Sepkowitz, Kent A.

AU - Zuccotti, Gianna

AU - Fraser, Victoria J.

AU - Warren, David K.

AU - Perl, Trish M.

AU - Speck, Kathleen

AU - Jernigan, John A.

AU - Robles, Jaime R.

AU - Wong, Edward S.

PY - 2009/1/1

Y1 - 2009/1/1

N2 - Objective: Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patients. Design, setting, and patients: Six ICUs at four academic centers measured the incidence of MRSA and VRE colonization and BSI during a period of bathing with routine soap for 6 months and then compared results with a 6-month period where all admitted patients received daily bathing with a chlorhexidine solution. Changes in incidence were evaluated by Poisson and segmented regression modeling. Interventions: Daily bathing with a chlorhexidine-containing solution. Measurements and main results: Acquisition of MRSA decreased 32% (5.04 vs. 3.44 cases/1000 patient days, p = 0.046) and acquisition of VREdecreased 50% (4.35 vs. 2.19 cases/1000 patient days, p = 0.008) following the introduction of daily chlorhexidine bathing. Segmented regression analysis demonstrated significant reductions in VRE bacteremia (p = 0.02) following the introduction of chlorhexidine bathing. VRE-colonized patients bathed with chlorhexidine had a lower risk of developing VRE bacteremia (relative risk 3.35; 95% confidence interval 1.13-9.87; p = 0.035), suggesting that reductions in the level of colonization led to the observed reductions in BSI. Conclusion: We conclude that daily chlorhexidine bathing among ICU patients may reduce the acquisition of MRSA and VRE. The approach is simple to implement and inexpensive and may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated BSI.

AB - Objective: Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patients. Design, setting, and patients: Six ICUs at four academic centers measured the incidence of MRSA and VRE colonization and BSI during a period of bathing with routine soap for 6 months and then compared results with a 6-month period where all admitted patients received daily bathing with a chlorhexidine solution. Changes in incidence were evaluated by Poisson and segmented regression modeling. Interventions: Daily bathing with a chlorhexidine-containing solution. Measurements and main results: Acquisition of MRSA decreased 32% (5.04 vs. 3.44 cases/1000 patient days, p = 0.046) and acquisition of VREdecreased 50% (4.35 vs. 2.19 cases/1000 patient days, p = 0.008) following the introduction of daily chlorhexidine bathing. Segmented regression analysis demonstrated significant reductions in VRE bacteremia (p = 0.02) following the introduction of chlorhexidine bathing. VRE-colonized patients bathed with chlorhexidine had a lower risk of developing VRE bacteremia (relative risk 3.35; 95% confidence interval 1.13-9.87; p = 0.035), suggesting that reductions in the level of colonization led to the observed reductions in BSI. Conclusion: We conclude that daily chlorhexidine bathing among ICU patients may reduce the acquisition of MRSA and VRE. The approach is simple to implement and inexpensive and may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated BSI.

KW - Bacteremia

KW - Chlorhexidine

KW - Enterococcus

KW - Methicillin resistance

KW - Staphylococcus aureus

KW - Vancomycin resistance

UR - http://www.scopus.com/inward/record.url?scp=66449116150&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66449116150&partnerID=8YFLogxK

U2 - 10.1097/CCM.0b013e31819ffe6d

DO - 10.1097/CCM.0b013e31819ffe6d

M3 - Review article

VL - 37

SP - 1858

EP - 1865

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 6

ER -