1. Home>
2. Specialties>
3. Infectious Diseases>
4. Summary and Comment

Chlorhexidine Bathing in the ICU

Chlorhexidine bathing significantly reduced the acquisition of MRSA and VRE, and the incidence of VRE bacteremia, in ICU patients.

In previous single-center studies (both partially supported by industry), bathing ICU patients daily with chlorhexidine reduced the acquisition of vancomycin-resistant enterococci (VRE) (JW Infect Dis Feb 24 2006) and the incidence of catheter-associated bloodstream infection (JW Infect Dis Oct 31 2007). Investigators now report results from a CDC-funded multicenter study of this intervention.

Nurses in six ICUs at four academic medical centers performed daily bed bathing of all patients (from the neck down). A 6-month baseline period, during which nonmedicated soap and water were used, was followed by a 6-month intervention period using chlorhexidine gluconate (4 oz. of 4% solution mixed in warm water). Throughout the study period, surveillance cultures for VRE and methicillin-resistant Staphylococcus aureus (MRSA) were performed on ICU admission and then at least weekly or on ICU discharge.

Rates of MRSA and VRE acquisition were 32% and 50% lower, respectively, during the intervention period than during the baseline period (3.4 vs. 5.0 MRSA acquisitions/1000 patient days [P=0.046]; 2.2 vs. 4.4 VRE acquisitions/1000 patient days [P=0.008]). The VRE bacteremia rate decreased by 73% (from 2.1 to 0.6 cases/1000 patient days [P=0.0006]) after the introduction of chlorhexidine bathing, whereas the MRSA bacteremia rate remained low and unchanged throughout the study period (<0.5 cases/1000 patient days).

Comment: Although limited by its before/after study design, this multicenter study raises the level of evidence supporting daily chlorhexidine bathing in the ICU. Chlorhexidine bathing is an attractive preventive intervention: It is simple, low risk, and likely to be effective against the full range of bacterial pathogens colonizing ICU patients. As its use becomes more widespread, surveillance will be needed for the emergence of chlorhexidine resistance.

— Daniel J. Diekema, MD, MS

Published in Journal Watch Infectious Diseases June 17, 2009

Citation(s):

Climo MW et al. 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. Crit Care Med 2009 Jun; 37:1858.

• Medline abstract (Free)