Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Nov 17;21(46):30400.
doi: 10.2807/1560-7917.ES.2016.21.46.30400.

Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: a systematic review and meta-analysis of randomised crossover trials

Elsa Afonso  1   2 , Koen Blot  2   3 , Stijn Blot  4   5
Affiliations
Meta-Analysis

Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: a systematic review and meta-analysis of randomised crossover trials

Elsa Afonso et al. Euro Surveill. .

Abstract

We assessed the impact of 2% daily patient bathing with chlorhexidine gluconate (CHG) washcloths on the incidence of hospital-acquired (HA) and central line-associated (CLA) bloodstream infections (BSI) in intensive care units (ICUs). We searched randomised studies in Medline, EMBASE, Cochrane Library (CENTRAL) and Web of Science databases up to April 2015. Primary outcomes were total HABSI, central line, and non-central line-associated BSI rates per patient-days. Secondary outcomes included Gram-negative and Gram-positive BSI rates and adverse events. Four randomised crossover trials involved 25 ICUs and 22,850 patients. Meta-analysis identified a total HABSI rate reduction (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.60-0.90; p = 0.002) with moderate heterogeneity (I2 = 36%). Subgroup analysis identified significantly stronger rate reductions (p = 0.01) for CLABSI (OR: 0.50; 95% CI: 0.35-0.71; p < 0.001) than other HABSI (OR: 0.82; 95% CI: 0.70-0.97; p = 0.02) with low heterogeneity (I2 = 0%). This effect was evident in the Gram-positive subgroup (OR: 0.55; 95% CI: 0.31-0.99; p = 0.05), but became non-significant after removal of a high-risk-of-bias study. Sensitivity analysis revealed that the intervention effect remained significant for total and central line-associated HABSI. We suggest that use of CHG washcloths prevents HABSI and CLABSI in ICUs, possibly due to the reduction in Gram-positive skin commensals.

Keywords: Intensive Care; healthcare-associated infections; hygiene; infection control; policy; prevention.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared. SB holds a research mandate of the Special Research Fund at Ghent University.

Figures

Figure 1
Figure 1
Study selection according to online databases
Figure 2
Figure 2
Summary of literature search and study selection (n = 291)
Figure 3
Figure 3
Meta-analysis of the impact of chlorhexidine gluconate washcloth bathing on total rate of hospital-acquired bloodstream infections per patient-days (n = 4 studies)
Figure 4
Figure 4
Subgroup analysis of rates of central line-associated bloodstream infection and non-central line-associated hospital-acquired bloodstream infection per patient days (n = 4 studies)
Figure 5
Figure 5
Subgroup analysis of rates of hospital-acquired Gram-positive and Gram-negative bloodstream infections per patient days (n = 4 studies)
See this image and copyright information in PMC

References

    1. European Antimicrobial Resistance Surveillance System (EARSS). EARSS annual report 2008. Bilthoven: EARSS; 2009. Available from: http://ecdc.europa.eu/en/healthtopics/antimicrobial-resistance-and-consu...
    1. Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol. 2008;29(11):996-1011. 10.1086/591861 - DOI - PubMed
    1. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011;32(2):101-14. 10.1086/657912 - DOI - PubMed
    1. Blot S, Vandewoude K, Hoste E, Colardyn F. Reappraisal of attributable mortality in critically ill patients with nosocomial bacteraemia involving Pseudomonas aeruginosa. J Hosp Infect. 2003;53(1):18-24. 10.1053/jhin.2002.1329 - DOI - PubMed
    1. Blot SI, Depuydt P, Annemans L, Benoit D, Hoste E, De Waele JJ, et al. Clinical and economic outcomes in critically ill patients with nosocomial catheter-related bloodstream infections. Clin Infect Dis. 2005;41(11):1591-8. 10.1086/497833 - DOI - PubMed

MeSH terms