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

Autor: Leah R Sanchez, Karen I Denison, Shirley K. Tran, Jimmy B Bersamin, Robert A Ochoa, Beverly A. Shirkey, Audrey D Magtoto, Lan N. Bui, Nelda P. Wray, Vy P. Pham, Michael L. Johnson, Jolene E Blackshear, Michelle O Butler, Jessica G Patel, Carol M. Ashton, Shaikh A Hai, Rubie May L Pomer, Edward A. Graviss, Joshua T. Swan
Rok vydání: 2016
Předmět:
Adult
Male
medicine.medical_specialty
Time Factors
Bathing
Comorbidity
030501 epidemiology
Critical Care and Intensive Care Medicine
Severity of Illness Index
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Coumarins
Risk Factors
Internal medicine
medicine
Clinical endpoint
Infection control
Humans
Surgical Wound Infection
030212 general & internal medicine
Aged
Aged
80 and over
Academic Medical Centers
Cross Infection
Infection Control
business.industry
Chlorhexidine
Ventilator-associated pneumonia
Pneumonia
Ventilator-Associated
Baths
Middle Aged
medicine.disease
Surgery
Pneumonia
Intensive Care Units
Isocoumarins
Bacteremia
Catheter-Related Infections
Anti-Infective Agents
Local
Commentary
Female
0305 other medical science
business
medicine.drug
Zdroj: Critical care medicine. 44(10)
ISSN: 1530-0293
Popis: 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.This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded.Twenty-four-bed surgical ICU at a quaternary academic medical center.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.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).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).Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.
Databáze: OpenAIRE
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