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A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units

Published online by Cambridge University Press:  10 February 2016

Kristen V. Dicks ,
Eric Lofgren ,
Sarah S. Lewis ,
Rebekah W. Moehring ,
Daniel J. Sexton  and
Deverick J. Anderson
Kristen V. Dicks*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Eric Lofgren
Affiliation:
Network Dynamics and Simulation Science Lab, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, Virginia
Sarah S. Lewis
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Rebekah W. Moehring
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina Durham Veterans Affairs Medical Center, Durham, North Carolina
Daniel J. Sexton
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
Deverick J. Anderson
Affiliation:
Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina Duke Infection Control Outreach Network, Durham, North Carolina
*
Address correspondence to Kristen V. Dicks, MD, MPH, PO Box 102359, Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC 27710 ([email protected]).
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Abstract

OBJECTIVE

To determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).

DESIGN

Interrupted time series analysis.

SETTING

The study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013.

PARTICIPANTS

All ICU patients at study hospitals during the study period.

METHODS

Of the 33 hospitals, 17 hospitals implemented CHG bathing during the study period, and 16 hospitals that did not perform CHG bathing served as controls. Primary pre-specified outcomes included ICU central-line–associated bloodstream infections (CLABSIs), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs). MRSA and VRE HAIs were also evaluated.

RESULTS

Chlorhexidine gluconate (CHG) bathing was associated with a significant downward trend in incidence rates of ICU CLABSI (incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.93–0.99), ICU primary BSI (IRR, 0.96; 95% CI, 0.94–0.99), VRE CLABSIs (IRR, 0.97; 95% CI, 0.97–0.98), and all combined VRE infections (IRR, 0.96; 95% CI, 0.93–1.00). No significant trend in MRSA infection incidence rates was identified prior to or following the implementation of CHG bathing.

CONCLUSIONS

In this multicenter, real-world analysis of the impact of CHG bathing, hospitals that implemented CHG bathing attained a decrease in ICU CLABSIs, ICU primary BSIs, and VRE CLABSIs. CHG bathing did not affect rates of specific or overall infections due to MRSA. Our findings support daily CHG bathing of ICU patients.

Infect Control Hosp Epidemiol 2016;37:791–797

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 791 - 797
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. An abstract containing preliminary data was presented at IDWeek, October 8, 2015, San Diego, California.

References

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