Chlorhexidine baths cut bacteremia in PICU

Chlorhexidine baths cut bacteremia in PICU
Chlorhexidine baths cut bacteremia in PICU

HealthDay News -- Bathing critically ill pediatric patients in chlorhexidine gluconate daily reduced the incidence of bacteremia by more than 35% in a randomized, crossover trial.

Bacteremia incidence in pediatric intensive care units (PICUs) that implemented daily chorhexidine baths was 3.28 per 1,000 patient-days, compared with 4.93 per 1,000 patient-days among PICUs with standard bathing practices (adjusted incidence ratio 0.64; 95% CI: 0.42-0.98), Aaron M. Milstone, MD, from the Johns Hopkins School of Medicine in Baltimore, and colleagues reported in Lancet.

"We have shown that a simple and easily implementable intervention decreased bacteremia in critically ill children," the researchers wrote.

They conducted an unmasked cluster-randomized, two-period crossover study to examine whether daily chlorhexidine baths reduced bacteremia in critically ill children, aged older than 2 months. The study included 4,947 patients at 10 pediatric intensive care units in five U.S. hospitals.

Instead of assigning individual patients to the intervention or a control, the unit of randomization was the PICU. Each center was randomized to perform the intervention or control on all admitted children for 6 months and then switch to the other hygiene method after a 2-week "washout" period.

Standard bathing was defined as a daily bath with plain soap and water, or daily full-body wipedown with a prepackaged non-antiseptic moist washcloth. Intervention was daily bathing using a cloth impregnated with 2% chlorhexidine gluconate. 

A total of 4,947 patients participated in the study, with 2,525 assigned to control and 2,422 to the intervention. In the per-protocol population, there was a total of 113 cases of bacteremia in 103 individual patients. This accounted for 34 cases in the intervention group vs. 79 in the standard practice group.

In the per-protocol group, bacteremia incidence was significantly reduced with chlorhexidine bathing compared with standard practice (3.28 vs. 4.93 per 1,000 days; aIR= 0.64; 95% CI: 0.42-0.98). There was also a trend toward reduced mortality in the intervention group (2.59% vs. 3.49%, P=0.11).

The benefit of the intervention was less clear in the intention to treat analysis, which showed a nonsignificant reduction in bacteremia incidence with chlorhexidine bathing compared with standard practice (3.52 vs. 4.93 per 1,000 days; aIR=0.71; 95% CI: 0.42-1.20).

There were no serious study-related adverse events, and the incidence of skin reactions linked to chlorhexidine was 1.2 per 1,000 days (95% CI: 0.60-2.02).

"Broad use of this intervention could reduce morbidity and costs from bacteremia in this vulnerable and understudied population," the researchers wrote. However, they acnowledged the need for more clinical trials to validate the findings.

Study limitations include the large number of participants for whom consent could not be obtained, lack of patient data on factors that could have affected bacteremia risk and the lack of a central review committee for bacteremia diagnoses at participating centers.

References

  1. Milstone A et al. Lancet. 2013; doi: 10.1016/S0140-6736(12)61687-0.
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