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746 Chlorhexidine (CHG) Bathing Reduces Healthcare-Associated Bloodstream Infection (HA-BSI) and Blood Culture Contaminants (BC-Contam): A Multiple Hospital Study of ICU and Respiratory Care Patients (Pts)

Sunday, March 21, 2010: 11:45 AM
International South (Hyatt Regency Atlanta)
Marisa A. Montecalvo, MD , Westchester Medical Center, Department of Infection Prevention and Control, Valhalla, NY
Donna McKenna, NP, MS , Westchester Medical Center, Department of Infection Prevention and Control, Valhalla, NY
Mack Lynda, RN , Westchester Medical Center, Department of Infection Prevention and Control, Valhalla, NY
Robert Yarrish, MD , Sound Shore Med Ctr, New Rochelle, NY
Guiqing Wang, MD, PhD , Westchester Medical Center, New York Medical College, Department of Pathology, Valhalla, NY
Janet P. Haas, DNSc , Westchester Medical Center, Department of Infection Prevention and Control, Valhalla, NY
Norine Dellarocco, RN, MSN , Sound Shore Med Ctr, New Rochelle, NY
Addie Rosenthal, RN, MS , Mt Vernon Hospital, Mt Vernon, NY
Barbara Savatteri, RN , Hudson Valley Hospital Center, Cortlandt Manor, NY
Anita Watson, RN, MSNed , Phelps Memorial Hospital Center, Sleepy Hollow, NY
Quihu Shi, PhD , New York Medical College School of Health Sciences and Practice, Valhalla, NY
Background:

In ICU pts, CHG bathing has been shown to reduce HA-BSI due to vancomycin resistant enterococci (VRE), and to reduce acquisition of VRE and methicillin resistant S. aureus (MRSA).   

Objective:

To determine the effect of CHG bathing on HA-BSI, central venous catheter (CVC) BSI and BC-Contam in respiratory care unit pts and ICU pts.

Methods:

Five hospitals evaluated CHG bathing in a pre-and post-intervention observational study from April 2008 until September 2009 using 2% CHG cloths (Sage Products, Cary Ill).  Exclusion criteria were pregnancy, breast feeding, CHG allergy, denuded skin.  CHG minimum inhibitory concentrations (MIC) were determined using broth microdilution.  

Results:

18, 357 CHG baths were given to 2011 pts.  Adverse events were one rash possibly related to CHG.  Compared with pre-CHG, during CHG there were statistically significant reductions in rates of HA-BSI (see table) [4.5 per 1000 pt days vs 1.95 per 1000 pt days, RR= 2.3, 95%CI= 1.5, 3.7, p <.001], CVC BSI [8.5 per 1000 pt days vs 3.9 per 1000 pt days, RR= 2.2,  95%CI=1.4,3.6, p=.002] and BC-Contam [2.9 per 1000 pt days vs 1.2 per 1000 pt days, RR=2.5, 95% CI=1.4,4.6,p=.002].  Respiratory care unit pts alone had statistically significant reductions in HA BSI [p=.02], CVC BSI [p=.04] and BC-Contam [p=.02].  During CHG, there were fewer HA BSIs due to Klebsiella pneumoniae, coagulase negative staphylococci,  MRSA, and Candida, whereas VRE BSIs increased; 4 of the 6 VRE BSI during CHG bathing were in neutropenic (ANC < 100) oncology pts in one ICU.  5 of these VRE isolates were tested and were susceptible to CHG (MIC= 2-4  micrograms/ml).   

Conclusions:

In a multiple hospital study of ICU and respiratory care unit pts, CHG bathing resulted in significant reductions of HA-BSI, CVC BSI and BC-Contam and was well tolerated.   Respiratory care unit pts alone had significant reductions in all endpoints. CHG bathing did not reduce VRE BSI, with most of these infections occurring in neutropenic oncology pts.  The effectiveness of CHG bathing in oncology pts is an area that requires further study.

Health Care Associated Bloodstream Infection 


 

Pre CHG
CHG Bathing
Hospital #
ICU Type
Median
LOS (days)
# HA BSI
Rate per 1000
Pt days
# HA BSI
Rate per 1000
Pt days
#1 Medical
5.0
7
5.8
9
3.9
#1 Respiratory
Care Unit 
35.8
31
7.5
15
3.5*
#2 Med- Surg
4.0
7
4.4
0
0**
#3 Med- Surg
4.0
4
5.1
1
1.1
#4 Med- Surg
5.0
4
1.6
2
1.8
#5 Med- Surg
3.0
4
1.6
0
0
TOTAL

 

57
4.5
27
1.95***
*p=.02; **p=.01;***p= <.001