Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial

Research output: Contribution to journalArticle

Joshua T. Swan, Carol M. Ashton, Lan N. Bui, Vy P. Pham, Beverly A. Shirkey, Jolene E. Blackshear, Jimmy B. Bersamin, Rubie May L Pomer, Michael L. Johnson, Audrey D. Magtoto, Michelle O. Butler, Shirley K. Tran, Leah R. Sanchez, Jessica G. Patel, Robert A. Ochoa, Shaikh A. Hai, Karen I. Denison, Edward A. Graviss, Nelda P. Wray

OBJECTIVE:: To test the hypothesis that compared with daily soap and water bathing, 2% chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients. DESIGN:: This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded. SETTING:: Twenty-four–bed surgical ICU at a quaternary academic medical center. PATIENTS:: Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included. INTERVENTIONS:: Patients were randomized to bathing with 2% chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm). MEASUREMENTS AND MAIN RESULTS:: The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95% CI, 0.309–0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0% (95% CI, 1.5–16.4%; p = 0.019). Incidences of adverse skin occurrences were similar (18.9% soap and water vs 18.6% chlorhexidine; p = 0.95). CONCLUSIONS:: Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.

Original languageEnglish (US)
JournalCritical care medicine
Early online dateJul 14 2016
DOIs
StatePublished - Oct 1 2016

PMID: 27428384

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Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU : A Single-Center, Randomized Controlled Trial. / Swan, Joshua T.; Ashton, Carol M.; Bui, Lan N.; Pham, Vy P.; Shirkey, Beverly A.; Blackshear, Jolene E.; Bersamin, Jimmy B.; Pomer, Rubie May L; Johnson, Michael L.; Magtoto, Audrey D.; Butler, Michelle O.; Tran, Shirley K.; Sanchez, Leah R.; Patel, Jessica G.; Ochoa, Robert A.; Hai, Shaikh A.; Denison, Karen I.; Graviss, Edward A.; Wray, Nelda P.

In: Critical care medicine, 01.10.2016.

Research output: Contribution to journalArticle

Harvard

Swan, JT, Ashton, CM, Bui, LN, Pham, VP, Shirkey, BA, Blackshear, JE, Bersamin, JB, Pomer, RML, Johnson, ML, Magtoto, AD, Butler, MO, Tran, SK, Sanchez, LR, Patel, JG, Ochoa, RA, Hai, SA, Denison, KI, Graviss, EA & Wray, NP 2016, 'Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial' Critical care medicine. https://doi.org/10.1097/CCM.0000000000001820

APA

Swan, J. T., Ashton, C. M., Bui, L. N., Pham, V. P., Shirkey, B. A., Blackshear, J. E., ... Wray, N. P. (2016). Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial. Critical care medicine. https://doi.org/10.1097/CCM.0000000000001820

Vancouver

Swan JT, Ashton CM, Bui LN, Pham VP, Shirkey BA, Blackshear JE et al. Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial. Critical care medicine. 2016 Oct 1. https://doi.org/10.1097/CCM.0000000000001820

Author

Swan, Joshua T. ; Ashton, Carol M. ; Bui, Lan N. ; Pham, Vy P. ; Shirkey, Beverly A. ; Blackshear, Jolene E. ; Bersamin, Jimmy B. ; Pomer, Rubie May L ; Johnson, Michael L. ; Magtoto, Audrey D. ; Butler, Michelle O. ; Tran, Shirley K. ; Sanchez, Leah R. ; Patel, Jessica G. ; Ochoa, Robert A. ; Hai, Shaikh A. ; Denison, Karen I. ; Graviss, Edward A. ; Wray, Nelda P. / Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU : A Single-Center, Randomized Controlled Trial. In: Critical care medicine. 2016.

BibTeX

@article{0f40f66c69564699960bbb3626a55eac,
title = "Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial",
abstract = "OBJECTIVE:: To test the hypothesis that compared with daily soap and water bathing, 2{\%} chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients. DESIGN:: This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded. SETTING:: Twenty-four–bed surgical ICU at a quaternary academic medical center. PATIENTS:: Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included. INTERVENTIONS:: Patients were randomized to bathing with 2{\%} chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm). MEASUREMENTS AND MAIN RESULTS:: The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95{\%} CI, 0.309–0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0{\%} (95{\%} CI, 1.5–16.4{\%}; p = 0.019). Incidences of adverse skin occurrences were similar (18.9{\%} soap and water vs 18.6{\%} chlorhexidine; p = 0.95). CONCLUSIONS:: Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5{\%} in surgical ICU patients.",
author = "Swan, {Joshua T.} and Ashton, {Carol M.} and Bui, {Lan N.} and Pham, {Vy P.} and Shirkey, {Beverly A.} and Blackshear, {Jolene E.} and Bersamin, {Jimmy B.} and Pomer, {Rubie May L} and Johnson, {Michael L.} and Magtoto, {Audrey D.} and Butler, {Michelle O.} and Tran, {Shirley K.} and Sanchez, {Leah R.} and Patel, {Jessica G.} and Ochoa, {Robert A.} and Hai, {Shaikh A.} and Denison, {Karen I.} and Graviss, {Edward A.} and Wray, {Nelda P.}",
year = "2016",
month = "10",
day = "1",
doi = "10.1097/CCM.0000000000001820",
language = "English (US)",
journal = "Critical care medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",

}

RIS

TY - JOUR

T1 - Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU

T2 - Critical care medicine

AU - Swan, Joshua T.

AU - Ashton, Carol M.

AU - Bui, Lan N.

AU - Pham, Vy P.

AU - Shirkey, Beverly A.

AU - Blackshear, Jolene E.

AU - Bersamin, Jimmy B.

AU - Pomer, Rubie May L

AU - Johnson, Michael L.

AU - Magtoto, Audrey D.

AU - Butler, Michelle O.

AU - Tran, Shirley K.

AU - Sanchez, Leah R.

AU - Patel, Jessica G.

AU - Ochoa, Robert A.

AU - Hai, Shaikh A.

AU - Denison, Karen I.

AU - Graviss, Edward A.

AU - Wray, Nelda P.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - OBJECTIVE:: To test the hypothesis that compared with daily soap and water bathing, 2% chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients. DESIGN:: This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded. SETTING:: Twenty-four–bed surgical ICU at a quaternary academic medical center. PATIENTS:: Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included. INTERVENTIONS:: Patients were randomized to bathing with 2% chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm). MEASUREMENTS AND MAIN RESULTS:: The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95% CI, 0.309–0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0% (95% CI, 1.5–16.4%; p = 0.019). Incidences of adverse skin occurrences were similar (18.9% soap and water vs 18.6% chlorhexidine; p = 0.95). CONCLUSIONS:: Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.

AB - OBJECTIVE:: To test the hypothesis that compared with daily soap and water bathing, 2% chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients. DESIGN:: This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded. SETTING:: Twenty-four–bed surgical ICU at a quaternary academic medical center. PATIENTS:: Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included. INTERVENTIONS:: Patients were randomized to bathing with 2% chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm). MEASUREMENTS AND MAIN RESULTS:: The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95% CI, 0.309–0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0% (95% CI, 1.5–16.4%; p = 0.019). Incidences of adverse skin occurrences were similar (18.9% soap and water vs 18.6% chlorhexidine; p = 0.95). CONCLUSIONS:: Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.

UR - http://www.scopus.com/inward/record.url?scp=84978737300&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84978737300&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000001820

DO - 10.1097/CCM.0000000000001820

M3 - Article

JO - Critical care medicine

JF - Critical care medicine

SN - 0090-3493

ER -

ID: 21860878