503 Hospital-Wide Chlorhexidine Patient Bathing Project

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Mark E. Rupp , University of Nebraska Medical Center, Omaha, NE
James R. Anderson , University of Nebraska Medical Center, Omaha, NE
R. Jennifer Cavalieri , University of Nebraska Medical Center, Omaha, NE
Teresa Fitzgerald , Nebraska Medical Center, Omaha, NE
Jennifer I. Kucera , University of Nebraska Medical Center, Omaha, NE
Elizabeth R. Lyden , University of Nebraska Medical Center, Omaha, NE
MaryAnn Martin , Nebraska Medical Center, Omaha, NE
Kate Tyner , Nebraska Medical Center, Omaha, NE
Trevor C. Vanschooneveld , University of Nebraska Medical Center, Omaha, NE
Background: Chlorhexidine (CHG) bathing of ICU patients has been associated with decreased rates of CLA-BSI and infection due to multi-drug resistant organisms.

Objective: Ascertain whether 3 day/week or everyday bathing with CHG reduces healthcare-associated infections (HAI) in ICU and non-ICU patients.

Methods: A quasi-experimental study was conducted in which bathing with a 4% CHG solution (Hibiclens®, Molnlycke Health Care) was instituted in a 3 month staggered schedule in 3 groups of patients: group 1) 5 critical care units (93 beds); group 2) 3 general med/surg and peds units (110 beds); and group 3) 7 medical and surgical subspecialty units (237 beds).  Each group was initially bathed 3 days per week (M/W/F) with CHG and, after 6 months, switched to everyday CHG bathing. The total intervention period lasted 18 months.  Device-associated infections and infections due to C. difficile, MRSA, and VRE were monitored per CDC NHSN recommendations. HAI rates during the intervention period were compared to 2008 historic control data.

Results:  68,302 CHG baths were administered during 112,620 patient days (60.6% compliance).  Compliance in the three adult ICUs (90.0%) was considerably greater than non-ICUs (57.7%).  A significant association between CHG bathing and a decrease in the rate of C. difficile infection (CDI) was observed in all three patient groups.  In the critical care units, the baseline CDI rate was 1.597/1000 patient days.  The relative risk of CDI compared to baseline during MWF bathing was 0.91 (P=0.72), but it declined markedly during everyday CHG bathing, RR 0.31 (P<0.0001).  In Group 2, the RR of CDI during MWF bathing declined to RR 0.67 (P=0.004) and decreased further to RR 0.44 (P=0.004) during everyday CHG bathing.  Similarly, in Group 3, the RR of CDI declined to 0.63 (P=0.002) during MWF bathing and decreased further to 0.50 (P=0.04) during everyday CHG bathing.  In the ICUs, the baseline rate of CLA-BSI was 4.168 which declined during MWF CHG bathing (RR 0.59, P=0.13) and remained relatively stable during everyday CHG bathing (RR 0.67, P=0.07).  A substantial change in the rate of CLA-BSI was not observed in Group 2.  In Group 3, the baseline rate of CLA-BSI of 1.86/1000 CVC days remained essentially stable during MWF bathing (RR 1.1, P=0.71) and decreased during everyday CHG bathing (RR 0.64, P=0.03).  The rate of CA-UTI did not change significantly in the ICU patient population but decreased significantly during MWF and everyday CHG bathing periods in the non-ICU populations: Group 2, RR 0.61 (P<0.0001), RR 0.27 (P<0.0001) and Group 3, RR 0.71 (P=0.004), RR 0.74 (P=0.02) for MWF and everyday CHG bathing, respectively.  The rates of infection due to MRSA and VRE were quite low which precluded meaningful comparisons.

Conclusions: Compliance with CHG bathing was greater in adult critical care units.  CHG bathing may have a beneficial effect in both ICU and non-ICU settings on a variety of HAIs.  However, multiple confounding variables may play a role.