Infection control · Decolonisation strategy
Chlorhexidine bathing and health care-associated infections
| Design | Pragmatic cluster-randomised crossover trial |
|---|---|
| Treatment | Daily chlorhexidine bathing |
| Control | Non-antimicrobial bathing |
| Population | Adult ICU patients across five units in a single academic centre |
| Follow-up | Two 10-week bathing periods with crossover |
| Primary endpoint | Composite of central line-associated bloodstream infection, catheter-associated urinary tract infection, ventilator-associated pneumonia and Clostridioides difficile |
| Result | 55 infections occurred during the chlorhexidine period (4 CLABSI, 21 CAUTI, 17 VAP, 13 C difficile) versus 60 during the control period (4 CLABSI, 32 CAUTI, 8 VAP, 16 C difficile) — no significant difference. |
| Secondary endpoints | Individual infection types, blood culture contamination, adverse skin reactions |
In this pragmatic trial, daily bathing with chlorhexidine did not reduce the incidence of health care-associated infections including CLABSIs, CAUTIs, VAP, or C difficile. These findings do not support daily bathing of critically ill patients with chlorhexidine.
The trial authors, in the published abstract
Sits awkwardly beside REDUCE MRSA, which found universal decolonisation effective. The difference may be baseline infection rates — this was a single centre with already low rates, leaving little to improve — or that mupirocin rather than chlorhexidine did the work in REDUCE.
Noto MJ, Domenico HJ, Byrne DW, et al. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA 2015 Jan 27;313(4):369-78.