Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections

Mark Edmund Rupp, R. Jennifer Cavalieri, Elizabeth Lyden, Jennifer Kucera, MaryAnn Martin, Teresa Fitzgerald, Kate Tyner, James R. Anderson, Trevor C VanSchooneveld

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background. Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs). Design. Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts. Setting. Academic medical center. Patients. All patients except neonates and infants. intervention and measurements. CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured. Results. Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%,). A significant decrease in infections due to Clostridium difficile P <.001 was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57-0.89; Pp.003) for 3-days-perweek CHG bathing and 0.41 (95% CI, 0.29-0.59; P <.001) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38-2.53; P=<.001), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported. Conclusions. CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized Patients.

Original languageEnglish (US)
Pages (from-to)1094-1100
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume33
Issue number11
DOIs
StatePublished - Nov 1 2012

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Chlorhexidine
Cross Infection
Clostridium difficile
Clostridium Infections
Confidence Intervals
Critical Care
Infection
Baths
chlorhexidine gluconate
Compliance

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections. / Rupp, Mark Edmund; Jennifer Cavalieri, R.; Lyden, Elizabeth; Kucera, Jennifer; Martin, MaryAnn; Fitzgerald, Teresa; Tyner, Kate; Anderson, James R.; VanSchooneveld, Trevor C.

In: Infection Control and Hospital Epidemiology, Vol. 33, No. 11, 01.11.2012, p. 1094-1100.

Research output: Contribution to journalArticle

Rupp, ME, Jennifer Cavalieri, R, Lyden, E, Kucera, J, Martin, M, Fitzgerald, T, Tyner, K, Anderson, JR & VanSchooneveld, TC 2012, 'Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections', Infection Control and Hospital Epidemiology, vol. 33, no. 11, pp. 1094-1100. https://doi.org/10.1086/668024
Rupp, Mark Edmund ; Jennifer Cavalieri, R. ; Lyden, Elizabeth ; Kucera, Jennifer ; Martin, MaryAnn ; Fitzgerald, Teresa ; Tyner, Kate ; Anderson, James R. ; VanSchooneveld, Trevor C. / Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections. In: Infection Control and Hospital Epidemiology. 2012 ; Vol. 33, No. 11. pp. 1094-1100.
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abstract = "Background. Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs). Design. Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts. Setting. Academic medical center. Patients. All patients except neonates and infants. intervention and measurements. CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured. Results. Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90{\%}) was better than that observed in other units (57.7{\%},). A significant decrease in infections due to Clostridium difficile P <.001 was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95{\%} confidence interval [CI], 0.57-0.89; Pp.003) for 3-days-perweek CHG bathing and 0.41 (95{\%} CI, 0.29-0.59; P <.001) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95{\%} CI, 1.38-2.53; P=<.001), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported. Conclusions. CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized Patients.",
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AU - Rupp, Mark Edmund

AU - Jennifer Cavalieri, R.

AU - Lyden, Elizabeth

AU - Kucera, Jennifer

AU - Martin, MaryAnn

AU - Fitzgerald, Teresa

AU - Tyner, Kate

AU - Anderson, James R.

AU - VanSchooneveld, Trevor C

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N2 - Background. Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs). Design. Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts. Setting. Academic medical center. Patients. All patients except neonates and infants. intervention and measurements. CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured. Results. Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%,). A significant decrease in infections due to Clostridium difficile P <.001 was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57-0.89; Pp.003) for 3-days-perweek CHG bathing and 0.41 (95% CI, 0.29-0.59; P <.001) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38-2.53; P=<.001), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported. Conclusions. CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized Patients.

AB - Background. Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs). Design. Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts. Setting. Academic medical center. Patients. All patients except neonates and infants. intervention and measurements. CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured. Results. Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%,). A significant decrease in infections due to Clostridium difficile P <.001 was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57-0.89; Pp.003) for 3-days-perweek CHG bathing and 0.41 (95% CI, 0.29-0.59; P <.001) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38-2.53; P=<.001), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported. Conclusions. CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized Patients.

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