The efficacy of chlorhexidine baths for reducing healthcare-associated bloodstream infection

Background: Prevention of healthcare-associated bloodstream infection is essential. Chlorhexidine baths have been proposed as an effective strategy for prevention of healthcare-associated BSI.  However, the magnitude of benefit is uncertain.

Objective: To assess the efficacy of chlorhexidine baths for prevention of healthcare-associated BSI using meta-analysis.  

Methods: Data Sources: Multiple computerized database searches supplemented by manual searches for relevant articles. Study Selection: Randomized, controlled trials and quasi-experimental studies evaluating efficacy of a chlorhexidine bathing compared with conventional soap and water bathing for prevention of healthcare-associated BSI. Data Extraction: Data were extracted on patient population, inclusion and exclusion criteria, diagnostic criteria for bloodstream infection and incidence of healthcare-associated BSI.

Data Synthesis: Data on incidence of healthcare-associated BSI  were abstracted as dichotomous variables. Pooled estimates of the relative risk (RR) and 95% confidence intervals (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenzel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I². Subgroup analyses were used to explore heterogeneity.

Results: Five controlled trials including a total of 9383 patients met the inclusion criteria. Overall, 0.82% (39/4755)  of patients developed healthcare-associated BSI in the treatment group compared with 2.5% (118/4628)  patients in the comparator group. Chlorhexidine bathing  resulted in a reduced incidence of healthcare-associated BSI, Pooled relative risk = 0.32 (95% CI = 0.22 to 0.46) P<0.0001, using a fixed-effects model. Results were similar using a random effects model. Heterogeneity was very low (I² 17%).

Conclusions: Our analysis showed that bathing with chlorhexidine compared with conventional soap and water is beneficial in preventing healthcare-associated BSI. Consideration should be given to chlorhexidine bathing for the prevention of healthcare-associated BSI. Cost-effectiveness analyses and comparative effectiveness strategies are recommended to determine the optimal frequency and concentration of chlorhexidine for prevention of healthcare-associated BSI.