Antimicrobial washcloths reduce ICU infections

Antimicrobial washcloths reduce ICU infections
Antimicrobial washcloths reduce ICU infections

HealthDay News -- Bathing hospitalized patients with antimicrobial washcloths improves infection control in the intensive care unit, study results indicate.

Wipedowns with chlorhexidine washcloths were associated with a 23% lower rate of multidrug-resistant organism acquisition (P=0.03) compared with non-antibacterial washing, Michael W. Climo, MD, of the McGuire Veterans Affairs Medical Center in Richmond, Va., and colleagues reported in New England Journal of Medicine.

Patients bathed with the antibacterial cloths also had a 28% lower rate of hospital-acquired bloodstream infections (P=0.007), the researchers noted.

Previous research has shown infection control benefits with chlorhexidine bathing. To further test this association, Climo and colleagues performed a multicenter, cluster-randomized, nonblinded crossover study that involved 7,727 patients in intensive care or bone marrow transplantation units.

Patients were bathed with either no-rinse 2% chlorhexidine-impregnated washcloths or with non-antimicrobial washcloths for six months and then monitored for bloodstream infections or multidrug-resistant organisms in the two days following each bathing period. The groups were then switched to the other product for the following six months.

The researchers also recorded mean length of stay, central venous catheter use, infection with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococcus (VRE) at time of admission, and monthly incidence and prevalence MRSA  and VRE colonization or infection.

During the study period, a total of 127 patients in the chlorhexidine bathing group acquired MRSA or VRE compared with 165 new cases in the group treated with non-antibacterial wash, for a rate of 6.10 vs. 5.10 cases per 1,000 patient-days (P=0.03).

Rates of hospital-acquired bloodstream infections were also lower among patients treated with chlorhexidine compared with those washed with non-antibacterial cloths (4.78 vs. 6.60 cases per 1,000 patient-days, P=0.007).

Overall risk over time in a Kaplan-Meier analysis was also significantly lower for chlorhexidine-bathed patients (P=0.02), with greater benefits observed for patients who were in the ICU longer. Patients in the ICU for more than 7 days who were bathed with chlorhexidine had a relative risk of 0.69 for primary bloodstream infection (95% CI: 0.47-0.99).

"Identifying simple, cost-effective, and safe strategies for the prevention of health care–associated infection is essential. Daily bathing with chlorhexidine-impregnated washcloths is a strategy that is relatively straightforward to implement and sustain because it does not require a substantial change from patient-bathing practices that are currently routine," the researchers concluded.

Both treatments were generally well-tolerated. Overall, there were 208 skin reactions -- 78 among those initially treated with chlorhexidine vs. 130 among those initially treated with non-antibacterial cloths. About 85% of skin reactions were considered mild to moderate. 


References

  1. Climo MW et al. "Effect of daily chlorhexidine bathing on hospital-acquired infection." N Engl J Med. 2013; 368: 533-542.
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