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Effectiveness of daily chlorhexidine bathing for reducing gram-negative infections: A meta-analysis

Published online by Cambridge University Press:  26 February 2019

Aditi Patel ,
Parth Parikh ,
Aaron N. Dunn ,
Jonathan A. Otter ,
Priyaleela Thota ,
Thomas G. Fraser ,
Curtis J. Donskey  and
Abhishek Deshpande
Aditi Patel
Affiliation:
Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
Parth Parikh
Affiliation:
Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
Aaron N. Dunn
Affiliation:
Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
Jonathan A. Otter
Affiliation:
National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU) in HCAI and AMR, Imperial College London & Public Health England, Hammersmith Hospital, London
Priyaleela Thota
Affiliation:
Hemex Health Incorporation, Portland, Oregon
Thomas G. Fraser
Affiliation:
Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Ohio
Curtis J. Donskey
Affiliation:
Geriatric Research, Education, and Clinical Center, Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
Abhishek Deshpande*
Affiliation:
Medicine Institute Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Ohio
*
Author for correspondence: Abhishek Deshpande, Email: [email protected]
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Abstract

Objective:

Multiple studies have demonstrated that daily chlorhexidine gluconate (CHG) bathing is associated with a significant reduction in infections caused by gram-positive pathogens. However, there are limited data on the effectiveness of daily CHG bathing on gram-negative infections. The aim of this study was to determine whether daily CHG bathing is effective in reducing the rate of gram-negative infections in adult intensive care unit (ICU) patients.

Design:

We searched MEDLINE and 3 other databases for original studies comparing daily bathing with and without CHG. Two investigators extracted data independently on baseline characteristics, study design, form and concentration of CHG, incidence, and outcomes related to gram-negative infections. Data were combined using a random-effects model and pooled relative risk ratios (RRs), and 95% confidence intervals (CIs) were derived.

Results:

In total, 15 studies (n = 34,895 patients) met inclusion criteria. Daily CHG bathing was not significantly associated with a lower risk of gram-negative infections compared with controls (RR, 0.89; 95% CI, 0.73–1.08; P = .24). Subgroup analysis demonstrated that daily CHG bathing was not effective for reducing the risk of gram-negative infections caused by Acinetobacter, Escherichia coli, Klebsiella, Enterobacter, or Pseudomonas spp.

Conclusions:

The use of daily CHG bathing was not associated with a lower risk of gram-negative infections. Further, better designed trials with adequate power and with gram-negative infections as the primary end point are needed.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 4 , April 2019 , pp. 392 - 399
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

a

Authors of equal contribution.

References

Milstone, AM, Passaretti, CL, Perl, TM. Chlorhexidine: expanding the armamentarium for infection control and prevention. Clin Infect Dis 2008;46:274–281.Google ScholarPubMed
Vernon, MO, Hayden, MK, Trick, WE, Hayes, RA, Blom, DW, Weinstein, RA. Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant enterococci. Arch Int Med 2006;166:306–312.CrossRefGoogle Scholar
Climo, MW, Yokoe, DS, Warren, DK, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med 2013;368:533–542.CrossRefGoogle ScholarPubMed
Gould, IM, MacKenzie, FM, MacLennan, G, Pacitti, D, Watson, EJ, Noble, DW. Topical antimicrobials in combination with admission screening and barrier precautions to control endemic methicillin-resistant Staphylococcus aureus in an intensive care unit. Int J Antimicrob Agents 2007;29:536–543.CrossRefGoogle Scholar
Noto, MJ, Domenico, HJ, Byrne, DW, et al. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA 2015;313:369–378.CrossRefGoogle ScholarPubMed
Cassir, N, Thomas, G, Hraiech, S, et al. Chlorhexidine daily bathing: impact on health care–associated infections caused by gram-negative bacteria. Am J Infect Control 2015;43:640–643.CrossRefGoogle ScholarPubMed
Boonyasiri, A, Thaisiam, P, Permpikul, C, et al. 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. Infect Control Hosp Epidemiol 2016;37:245–253.CrossRefGoogle ScholarPubMed
Camus, C, Bellissant, E, Sebille, V, et al. Prevention of acquired infections in intubated patients with the combination of two decontamination regimens. Crit Care Med 2005;33:307–314.CrossRefGoogle ScholarPubMed
Derde, LP, Dautzenberg, MJ, Bonten, MJ. Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review. Intensive Care Med 2012;38:931–939.CrossRefGoogle ScholarPubMed
Kim, HY, Lee, WK, Na, S, Roh, YH, Shin, CS, Kim, J. The effects of chlorhexidine gluconate bathing on health care–associated infection in intensive care units: a meta-analysis. J Crit Care 2016;32:126–137.CrossRefGoogle ScholarPubMed
Chen, W, Cao, Q, Li, S, Li, H, Zhang, W. Impact of daily bathing with chlorhexidine gluconate on ventilator-associated pneumonia in intensive care units: a meta-analysis. J Thoracic Dis 2015;7:746.Google ScholarPubMed
Frost, SA, Alogso, M-C, Metcalfe, L, et al. Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Crit Care 2016;20:379.CrossRefGoogle ScholarPubMed
Afonso, E, Blot, K, Blot, S. Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: a systematic review and meta-analysis of randomised crossover trials. Euro Surveill 2016;21:pii: 30400. doi: 10.2807/1560-7917.ES.2016.21.46.30400.CrossRefGoogle ScholarPubMed
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Group, P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epi 2009;62:1006–1012.CrossRefGoogle ScholarPubMed
Wells, G, Shea, B, O’Connell, D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Ottawa Health Research Institute website. http://www.ohri.ca/PROGRAMS/CLINICAL_EPIDEMIOLOGY/OXFORD.ASP. Published 2012. Accessed July 2, 2018.Google Scholar
Higgins, JP, Thompson, SG. Quantifying heterogeneity in a meta–analysis. Stat Med 2002;21:1539–1558.CrossRefGoogle ScholarPubMed
Deeks, JJ, Higgins, JP, Altman, DG. Analysing data and undertaking meta–analyses. In: Higgins, JPT and Green, S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Chichester, UK: John Wiley & Sons; 2008:243–296.CrossRefGoogle Scholar
Egger, M, Smith, GD, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629–634.CrossRefGoogle ScholarPubMed
Duval, S, Tweedie, R. Trim and fill: a simple funnel–plot–based method of testing and adjusting for publication bias in meta–analysis. Biometrics 2000;56:455–463.CrossRefGoogle ScholarPubMed
Apisarnthanarak, A, Hsu, LY, Lim, T-P, Mundy, LM. Increase in chlorhexidine minimal inhibitory concentration of Acinetobacter baumannii clinical isolates after implementation of advanced source control. Infect Control Hosp Epidemiol 2014;35:98–99.CrossRefGoogle ScholarPubMed
Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Int Med 2007;167:2073–2079.CrossRefGoogle ScholarPubMed
Chung, YK, Kim, J-S, Lee, SS, et al. Effect of daily chlorhexidine bathing on acquisition of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit with CRAB endemicity. Am J Infect Control 2015;43:1171–1177.CrossRefGoogle ScholarPubMed
Dicks, KV, Lofgren, E, Lewis, SS, Moehring, RW, Sexton, DJ, Anderson, DJ. A multicenter pragmatic interrupted time series analysis of chlorhexidine gluconate bathing in community hospital intensive care units. Infect Control Hosp Epidemiol 2016;37:791–797.CrossRefGoogle ScholarPubMed
Evans, HL, Dellit, TH, Chan, J, Nathens, AB, Maier, RV, Cuschieri, J. Effect of chlorhexidine whole-body bathing on hospital-acquired infections among trauma patients. Arch Surg 2010;145:240–246.CrossRefGoogle ScholarPubMed
Martínez-Reséndez, MF, Garza-González, E, Mendoza-Olazaran, S, et al. Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients. Am J Infect Control 2014;42:713–717.CrossRefGoogle ScholarPubMed
Montecalvo, MA, McKenna, D, Yarrish, R, et al. Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability. Am J Med 2012;125:505–511.CrossRefGoogle ScholarPubMed
Hong, J, Jang, OJ, Bak, MH, et al. Management of carbapenem-resistant Acinetobacter baumannii epidemic in an intensive care unit using multifaceted intervention strategy. Korean J Intern Med 2018;33:1000–1007.CrossRefGoogle Scholar
Urbancic, KF, Martensson, J, Glassford, N, et al. Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition. Crit Care Resusc 2018;20:109–116.Google ScholarPubMed
Pittet, D, Allegranzi, B, Boyce, J, World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30:611–622.CrossRefGoogle ScholarPubMed
Hassan, KA, Jackson, SM, Penesyan, A, et al. Transcriptomic and biochemical analyses identify a family of chlorhexidine efflux proteins. Proc Natl Acad Sci U S A 2013;110:20254–20259.CrossRefGoogle ScholarPubMed
McDonnell, G, Russell, AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999;12:147–179.CrossRefGoogle ScholarPubMed
Supple, L, Kumaraswami, M, Kundrapu, S, et al. Chlorhexidine only works if applied correctly: use of a simple colorimetric assay to provide monitoring and feedback on effectiveness of chlorhexidine application. Infect Control Hosp Epidemiol 2015;36:1095–1097.CrossRefGoogle ScholarPubMed
Warn, D, Thompson, S, Spiegelhalter, D. Bayesian random effects meta–analysis of trials with binary outcomes: methods for the absolute risk difference and relative risk scales. Stat Med 2002;21:1601–1623.CrossRefGoogle ScholarPubMed
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