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Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand

Published online by Cambridge University Press:  27 November 2015

Adhiratha Boonyasiri ,
Peerapat Thaisiam ,
Chairat Permpikul ,
Tepnimitr Judaeng ,
Bordeesuda Suiwongsa ,
Napaporn Apiradeewajeset ,
Teerawan Fakthongphan ,
Sunun Suddee ,
Wandee Laoagtipparos  and
Visanu Thamlikitkul
Adhiratha Boonyasiri*
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Peerapat Thaisiam
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chairat Permpikul
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Tepnimitr Judaeng
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Bordeesuda Suiwongsa
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Napaporn Apiradeewajeset
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Teerawan Fakthongphan
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Sunun Suddee
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Wandee Laoagtipparos
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Visanu Thamlikitkul
Affiliation:
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
*
Address correspondence to Adhiratha Boonyasiri, MD, Faculty of Medicine Siriraj Hospital, Mahidol University Bangkok, 10700 Thailand ([email protected]).
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Abstract

OBJECTIVE

To determine the effectiveness of daily bathing with 2% chlorhexidine-impregnated washcloths in preventing multidrug-resistant (MDR) gram-positive bacterial colonization and bloodstream infection.

METHODS

A randomized, open-label controlled trial was conducted in 4 medical intensive care units (ICUs) in Thailand from December 2013 to January 2015. Patients were randomized to receive cleansing with non-antimicrobial soap (control group) or 2% chlorhexidine-impregnated washcloths used to wipe the patient’s body once daily (chlorhexidine group). Swabs were taken from nares, axilla, antecubital, groin, and perianal areas on admission and on day 3, 5, 7, and 14. The 5 outcomes were (1) favorable events ( all samples negative throughout ICU admission, or initially positive samples with subsequent negative samples); (2) MDR bacteria colonization-free time; (3) hospital-acquired infection; (4) length of ICU and hospital stay; (5) adverse skin reactions.

RESULTS

A total of 481 patients were randomly assigned to the control group (241) or the chlorhexidine group (240). Favorable events at day 14 were observed in 34.8% of patients in the control group and 28.6% in the chlorhexidine group (P=.79). Median MDR bacteria colonization-free times were 5 days in both groups. The incidence rate of hospital-acquired infection and the length of the ICU and hospital stay did not differ significantly between groups. The incidence of adverse skin reactions in the chlorhexidine group was 2.5%.

CONCLUSION

The effectiveness of 2% chlorhexidine-impregnated washcloths for the prevention of MDR gram-negative bacteria colonization and hospital-acquired infection in adult patients in ICU was not proven.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT01989416.

Infect. Control Hosp. Epidemiol. 2016;37(3):245–253

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 3 , March 2016 , pp. 245 - 253
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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