In this cluster-randomized study at ICUs in six hospitals, chlorhexidine-impregnated washcloths were associated with significantly lower rates of bloodstream infections and acquisition of multidrug-resistant organisms than were nonantimicrobial washcloths.
Multidrug-resistant organisms (MDROs), including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE), have become endemic in many acute care and long-term care facilities. Infections with these organisms are often difficult to treat, owing to a dwindling armamentarium of active antimicrobial agents.
• What is the mechanism of action of chlorhexidine?
Chlorhexidine gluconate is an antiseptic agent that has broad-spectrum activity against many organisms, including S. aureus and enterococcus species. Unlike many other antiseptics, chlorhexidine has residual antibacterial activity, which may decrease the microbial burden on patients’ skin and prevent secondary environmental contamination.
• What were the most common pathogens responsible for bloodstream infections in this study of patients in intensive care or transplant units?
Among the 221 primary bloodstream infections, the most common pathogens were staphylococci (30%), gram-negative bacilli (23%), enterococci (20%), and fungi (13%).
Morning Report Questions
Q: What were the primary results in this study of daily bathing with chlorhexidine-impregnated washcloths in an intensive-care unit setting?
A: The overall rate of MRSA or VRE acquisition was 23% lower during the intervention period. The rate of hospital-acquired bloodstream infections was 28% lower during the intervention period than during the control period (4.78 vs. 6.60 cases per 1000 patient-days, P=0.007). The rate of central-catheter-associated bloodstream infections was 53% lower during the intervention period than during the control period (1.55 vs. 3.30 cases per 1000 catheter-days,
P=0.004). The incidence rate of primary bloodstream infection caused by coagulase-negative staphylococci was 56% lower during the intervention period than during the control period (0.60 vs. 1.36 cases per 1000 patient-days, P=0.008). Similarly, the incidence rate of primary bloodstream infection caused by fungi was 53% lower during the intervention period than during the control period, but this finding was not significant (0.36 vs. 0.76 cases per 1000 patient-days, P=0.06).
Q: Where adverse effects were associated with the use of chlorhexidine in this study?
A: The authors did not identify any serious adverse effects of daily bathing with the chlorhexidine-based washcloths. Serious allergic reactions have been reported with the topical use of chlorhexidine, but these reactions appear to be rare. No MRSA or VRE isolates with high-level resistance to chlorhexidine were detected during the study.