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LB 14 Adverse Events Associated with Daily Chlorhexidine Gluconate (CHG) Bathing in Critically Ill Children: Result from a Multicenter, Cluster Randomized, Controlled, Crossover Trial

Sunday, April 3, 2011: 3:30 PM
Coronado BCD (Hilton Anatole)
Aaron M. Milstone, MD, MHS , Johns Hopkins Medical Institutions, Baltimore, MD
Alexis Elward, MD , Washington University School of Medicine, St. Louis, MO
Xiaoyan Song, MD , Children's National Medical Center, Washington, DC
Danielle Zerr, MD, MPH , University of Washington, Seattle, WA
Rachel C. Orscheln, MD , Washington University School of Medicine, Saint Louis, MO
Susan E. Coffin, MD, MPH , Children's Hospital of Philadelphia, Philadelphia, PA
Trish M. Perl, MD, MSc , The Johns Hopkins Medical Institutions, Baltimore, MD
Background: Recent studies suggest that daily CHG baths may reduce the incidence of bacteremia and prevent transmission of multidrug resistant organisms in adult intensive care units (ICU).  The safety and efficacy of daily CHG bathing in hospitalized children has not been studied. 

Objective:  To characterize adverse events in children receiving daily CHG baths in ICUs. 

Methods: We performed a crossover study using cluster-randomization in 10 pediatric ICUs at 5 academic medical centers. Patients more than 2 months of age were eligible.  In each ICU, 2 bathing regimens (daily bathing with 2% CHG impregnated cloths or routine bathing practices) were used for 2 six-month study periods separated by a two-week washout period. The primary study outcome was bacteremia, including episodes caused by common skin contaminants. Adverse events were reported in those enrolled.  Rashes were reported by the patients’ clinical teams, who determined whether the rashes were likely related to CHG bathing.

Results:  Post-randomization, there were 2441 patient admissions in the control units and 1864 on treatment in the intervention units. Of the 1,864 on treatment, 188 (10%) were bathed with CHG for at least 2 weeks and 51 (2.7%) for at least 1 month. No serious adverse events were reported.  The only reported events were skin reactions.  Overall, rashes were reported in 63 patient admissions (1.5%), 43 (2.3%) in those on treatment and 20 (0.8%) in the control group (p<.01). Of those rashes in patients on treatment, 14 episodes (33%) were determined to be likely related to CHG bathing and 29 (67%) were felt to be unrelated to CHG bathing. All CHG related skin reactions were mild dermatitis including macular or maculopapular erythema. There was no difference in the proportion of rashes likely related to CHG bathing and the proportion of rashes reported in the control groups (0.75% vs. 0.8%; p=.85).  6 children (0.3%) had daily CHG baths discontinued due to a rash, 2 felt likely related to CHG bathing and 4 felt likely unrelated.

Conclusions: Daily CHG bathing of critically ill children is safe and not associated with significant adverse events.  More skin reactions were reported in the treatment group compared with the control group, but there was no difference when comparing rashes determined to be likely related to CHG bathing.  Whether daily bathing with CHG compared with standard bathing practices reduces bacteremia in critically ill children requires further analysis.