Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition

Karen F. Urbancic, Johan Mårtensson, Neil Glassford, Christopher Eyeington, Raymond Robbins, Peter B. Ward, Darren Williams, Paul D.R. Johnson, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

6 Citations (Scopus)

Abstract

Background: Chlorhexidine gluconate (CHG) bathing has been reported to decrease bloodstream infections and colonisation of multidrug-resistant organisms (MROs) in intensive care units (ICUs). However, its effectiveness in an Australian setting has not been assessed. Objective: To test whether the introduction of ICU-wide CHG bathing in place of triclosan would affect rates of the primary outcome of central line-associated bloodstream infections (CLABSI), or the secondary outcomes of ICUacquired positive blood cultures or other clinical specimens, and MRO colonisation including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Methods: We conducted a single-centre, sequential, beforeand- after observational study. Patient microbiological and clinical data were compared in the 12 months before and after the introduction of CHG bathing in the ICU. Results: A total of 4262 ICU admissions were studied, 2117 before and 2145 during the CHG-bathing period. There were no signifi cant changes in the rates of CLABSI (from 1.69/1000 central venous catheter-days [95% CI, 0.68-3.48] to 1.33 [95% CI, 0.49-2.90]; P = 0.68), or ICUacquired positive blood cultures (from 5.14/1000 patientdays [95% CI, 3.45-7.39] to 4.45 [95% CI, 3.00-6.36]; P = 0.58). However, we observed a lower incidence of MRSA acquisition during the CHG-bathing period (mean difference, −2.13 [95% CI, −3.65 to −0.60] per 1000 patient-days; P = 0.007). There was no difference in the rate of isolates involving other pathogens including VRE. Conclusions: In a tertiary Australian ICU, routine CHG bathing compared with triclosan did not affect the rates of ICU-acquired CLABSI or positive blood cultures. However, it signifi cantly decreased the incidence of MRSA acquisition.

Original languageEnglish
Pages (from-to)109-116
Number of pages8
JournalCritical Care and Resuscitation
Volume20
Issue number2
Publication statusPublished - 1 Jun 2018

Cite this

Urbancic, Karen F. ; Mårtensson, Johan ; Glassford, Neil ; Eyeington, Christopher ; Robbins, Raymond ; Ward, Peter B. ; Williams, Darren ; Johnson, Paul D.R. ; Bellomo, Rinaldo. / Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition. In: Critical Care and Resuscitation. 2018 ; Vol. 20, No. 2. pp. 109-116.
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title = "Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition",
abstract = "Background: Chlorhexidine gluconate (CHG) bathing has been reported to decrease bloodstream infections and colonisation of multidrug-resistant organisms (MROs) in intensive care units (ICUs). However, its effectiveness in an Australian setting has not been assessed. Objective: To test whether the introduction of ICU-wide CHG bathing in place of triclosan would affect rates of the primary outcome of central line-associated bloodstream infections (CLABSI), or the secondary outcomes of ICUacquired positive blood cultures or other clinical specimens, and MRO colonisation including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Methods: We conducted a single-centre, sequential, beforeand- after observational study. Patient microbiological and clinical data were compared in the 12 months before and after the introduction of CHG bathing in the ICU. Results: A total of 4262 ICU admissions were studied, 2117 before and 2145 during the CHG-bathing period. There were no signifi cant changes in the rates of CLABSI (from 1.69/1000 central venous catheter-days [95{\%} CI, 0.68-3.48] to 1.33 [95{\%} CI, 0.49-2.90]; P = 0.68), or ICUacquired positive blood cultures (from 5.14/1000 patientdays [95{\%} CI, 3.45-7.39] to 4.45 [95{\%} CI, 3.00-6.36]; P = 0.58). However, we observed a lower incidence of MRSA acquisition during the CHG-bathing period (mean difference, −2.13 [95{\%} CI, −3.65 to −0.60] per 1000 patient-days; P = 0.007). There was no difference in the rate of isolates involving other pathogens including VRE. Conclusions: In a tertiary Australian ICU, routine CHG bathing compared with triclosan did not affect the rates of ICU-acquired CLABSI or positive blood cultures. However, it signifi cantly decreased the incidence of MRSA acquisition.",
author = "Urbancic, {Karen F.} and Johan M{\aa}rtensson and Neil Glassford and Christopher Eyeington and Raymond Robbins and Ward, {Peter B.} and Darren Williams and Johnson, {Paul D.R.} and Rinaldo Bellomo",
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Urbancic, KF, Mårtensson, J, Glassford, N, Eyeington, C, Robbins, R, Ward, PB, Williams, D, Johnson, PDR & Bellomo, R 2018, 'Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition', Critical Care and Resuscitation, vol. 20, no. 2, pp. 109-116.

Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition. / Urbancic, Karen F.; Mårtensson, Johan; Glassford, Neil; Eyeington, Christopher; Robbins, Raymond; Ward, Peter B.; Williams, Darren; Johnson, Paul D.R.; Bellomo, Rinaldo.

In: Critical Care and Resuscitation, Vol. 20, No. 2, 01.06.2018, p. 109-116.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Impact of unit-wide chlorhexidine bathing in intensive care on bloodstream infection and drug-resistant organism acquisition

AU - Urbancic, Karen F.

AU - Mårtensson, Johan

AU - Glassford, Neil

AU - Eyeington, Christopher

AU - Robbins, Raymond

AU - Ward, Peter B.

AU - Williams, Darren

AU - Johnson, Paul D.R.

AU - Bellomo, Rinaldo

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: Chlorhexidine gluconate (CHG) bathing has been reported to decrease bloodstream infections and colonisation of multidrug-resistant organisms (MROs) in intensive care units (ICUs). However, its effectiveness in an Australian setting has not been assessed. Objective: To test whether the introduction of ICU-wide CHG bathing in place of triclosan would affect rates of the primary outcome of central line-associated bloodstream infections (CLABSI), or the secondary outcomes of ICUacquired positive blood cultures or other clinical specimens, and MRO colonisation including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Methods: We conducted a single-centre, sequential, beforeand- after observational study. Patient microbiological and clinical data were compared in the 12 months before and after the introduction of CHG bathing in the ICU. Results: A total of 4262 ICU admissions were studied, 2117 before and 2145 during the CHG-bathing period. There were no signifi cant changes in the rates of CLABSI (from 1.69/1000 central venous catheter-days [95% CI, 0.68-3.48] to 1.33 [95% CI, 0.49-2.90]; P = 0.68), or ICUacquired positive blood cultures (from 5.14/1000 patientdays [95% CI, 3.45-7.39] to 4.45 [95% CI, 3.00-6.36]; P = 0.58). However, we observed a lower incidence of MRSA acquisition during the CHG-bathing period (mean difference, −2.13 [95% CI, −3.65 to −0.60] per 1000 patient-days; P = 0.007). There was no difference in the rate of isolates involving other pathogens including VRE. Conclusions: In a tertiary Australian ICU, routine CHG bathing compared with triclosan did not affect the rates of ICU-acquired CLABSI or positive blood cultures. However, it signifi cantly decreased the incidence of MRSA acquisition.

AB - Background: Chlorhexidine gluconate (CHG) bathing has been reported to decrease bloodstream infections and colonisation of multidrug-resistant organisms (MROs) in intensive care units (ICUs). However, its effectiveness in an Australian setting has not been assessed. Objective: To test whether the introduction of ICU-wide CHG bathing in place of triclosan would affect rates of the primary outcome of central line-associated bloodstream infections (CLABSI), or the secondary outcomes of ICUacquired positive blood cultures or other clinical specimens, and MRO colonisation including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Methods: We conducted a single-centre, sequential, beforeand- after observational study. Patient microbiological and clinical data were compared in the 12 months before and after the introduction of CHG bathing in the ICU. Results: A total of 4262 ICU admissions were studied, 2117 before and 2145 during the CHG-bathing period. There were no signifi cant changes in the rates of CLABSI (from 1.69/1000 central venous catheter-days [95% CI, 0.68-3.48] to 1.33 [95% CI, 0.49-2.90]; P = 0.68), or ICUacquired positive blood cultures (from 5.14/1000 patientdays [95% CI, 3.45-7.39] to 4.45 [95% CI, 3.00-6.36]; P = 0.58). However, we observed a lower incidence of MRSA acquisition during the CHG-bathing period (mean difference, −2.13 [95% CI, −3.65 to −0.60] per 1000 patient-days; P = 0.007). There was no difference in the rate of isolates involving other pathogens including VRE. Conclusions: In a tertiary Australian ICU, routine CHG bathing compared with triclosan did not affect the rates of ICU-acquired CLABSI or positive blood cultures. However, it signifi cantly decreased the incidence of MRSA acquisition.

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