PMID- 30153786
OWN - NLM
STAT- MEDLINE
DCOM- 20181002
LR  - 20201209
IS  - 1441-2772 (Print)
IS  - 1441-2772 (Linking)
VI  - 20
IP  - 3
DP  - 2018 Sep
TI  - Chlorhexidine washing in intensive care does not reduce bloodstream infections, 
      blood culture contamination and drug-resistant microorganism acquisition: an 
      interrupted time series analysis.
PG  - 231-240
AB  - BACKGROUND: Health care-associated infections are a major cause of morbidity and 
      mortality in intensive care patients. The effect of daily washing with 
      chlorhexidine on these infections is controversial. METHODS: Single-centre, 
      retrospective, open-label, sequential period, interrupted time series (ITS) 
      analysis in a 31-bed tertiary referral mixed intensive care unit (ICU), comparing 
      daily washing with water and soap (from January 2011 to August 2013) with 
      chlorhexidine washing (from November 2013 to December 2015), after the 
      introduction of a unit-level policy of chlorhexidine washing. All patients in the 
      ICU were included in the study, except: if they were under 18 years of age, if 
      their ICU stay was less than 24 hours (to ensure that all studied patients had at 
      least one exposure to the daily wash intervention), or if patients had a known 
      allergy to chlorhexidine. Outcome measures included: clinically significant 
      positive blood cultures attributable to the ICU stay; contaminated blood 
      cultures; newly acquired multidrug-resistant microorganisms (MDRO) such as 
      methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant 
      enterococcus (VRE) or multidrug-resistant gram-negative (MRGN) isolates 
      attributable to ICU from clinical and screening cultures; and newly acquired 
      Clostridium difficile infections (CDIs). Incidence rates of these outcomes were 
      calculated per 1000 patient days. MDRO acquisition rates were corrected for 
      background hospital period prevalence rates of MDRO. RESULTS: A total of 6634 
      patients were included in the study. ITS analysis showed no significant level or 
      slope changes in any of the outcome measures after implementation of 
      chlorhexidine washing. The incidence rate of clinically significant positive 
      blood cultures during the chlorhexidine period compared with the water and soap 
      period was 3.6 v 4.7 (P =0.37); blood culture contamination rates were 11.8 v 9.5 
      (P =0.56); incidence rates of new ICU-associated MDRO acquisitions were 3.22 v 
      3.69 (P =0.27); incidence rates of new CDI were 2.01 v 0.79 (P =0.16). Outcomes 
      after adjustment for known and potential confounders were similar. CONCLUSIONS: 
      In this real-world, long term ICU study, implementation of a unit-level policy of 
      daily washing with chlorhexidine impregnated cloths was not associated with a 
      reduction in the rates of ICU-associated clinically significant positive blood 
      cultures, blood culture contamination, newly acquired MDRO isolates, and CDIs.
FAU - Kengen, Roel
AU  - Kengen R
AD  - Intensive Care Unit, Canberra Hospital, Woden, ACT, Australia. 
      frank.vanharen@act.gov.au.
FAU - Thoonen, Elcke
AU  - Thoonen E
AD  - Intensive Care Unit, Canberra Hospital, Woden, ACT, Australia.
FAU - Daveson, Kathryn
AU  - Daveson K
AD  - Infectious Diseases and Microbiology, Canberra Hospital, Woden, ACT, Australia.
FAU - Loong, Bronwyn
AU  - Loong B
AD  - Research School of Finance, Actuarial Studies and Applied Statistics, Australian 
      National University, Canberra, ACT, Australia.
FAU - Rodgers, Helen
AU  - Rodgers H
AD  - Intensive Care Unit, Canberra Hospital, Woden, ACT, Australia.
FAU - Beckingham, Wendy
AU  - Beckingham W
AD  - Infection Prevention and Control, Canberra Hospital, Woden, ACT, Australia.
FAU - Kennedy, Karina
AU  - Kennedy K
AD  - Infectious Diseases and Microbiology, Canberra Hospital, Woden, ACT, Australia.
FAU - Suwandarathne, Ruwan
AU  - Suwandarathne R
AD  - Intensive Care Unit, Canberra Hospital, Woden, ACT, Australia.
FAU - van Haren, Frank
AU  - van Haren F
AD  - Intensive Care Unit, Canberra Hospital, Woden, ACT, Australia.
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Crit Care Resusc
JT  - Critical care and resuscitation : journal of the Australasian Academy of Critical 
      Care Medicine
JID - 100888170
RN  - 0 (Anti-Infective Agents, Local)
RN  - R4KO0DY52L (Chlorhexidine)
SB  - IM
MH  - Anti-Infective Agents, Local/*administration & dosage
MH  - Bacteremia/*prevention & control
MH  - *Baths
MH  - Blood-Borne Pathogens
MH  - Chlorhexidine/*administration & dosage
MH  - Clinical Protocols
MH  - Clostridioides difficile/drug effects
MH  - Cross Infection/*prevention & control
MH  - Drug Resistance, Multiple, Bacterial
MH  - Enterococcus/drug effects
MH  - Female
MH  - Gram-Negative Bacterial Infections/prevention & control
MH  - Humans
MH  - *Intensive Care Units
MH  - Interrupted Time Series Analysis
MH  - Male
MH  - Methicillin-Resistant Staphylococcus aureus/drug effects
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Vancomycin Resistance
EDAT- 2018/08/30 06:00
MHDA- 2018/10/03 06:00
CRDT- 2018/08/30 06:00
PHST- 2018/08/30 06:00 [entrez]
PHST- 2018/08/30 06:00 [pubmed]
PHST- 2018/10/03 06:00 [medline]
PST - ppublish
SO  - Crit Care Resusc. 2018 Sep;20(3):231-240.