Chlorhexidine Baths Slash PICU Bacteremia Risk

Yael Waknine

February 07, 2013

Scrubbing critically ill kids with chlorhexidine (CHG) may cut their risk for bacteremia by 36%, according to a study published online January 26 in the Lancet.

Pediatric infectious disease specialist Aaron Milstone, MD, MHS, from the Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, and colleagues found that using CHG wipes yielded a per protocol (PP) bacteremia rate of 3.28 95% confidence interval [CI], 2.27 - 4.58) and an intent-to-treat (ITT) bacteremia rate of 3.52 (95% CI, 2.64 - 4.61) per 1000 patient-days.

As such, the intervention significantly decreased infection rates for the PP population (adjusted incidence rate ratio [aIRR], 0.64; 95% CI, 0.42 - 0.98), but not the overall ITT group, which included the 33% of eligible patients excluded for nonconsent (aIRR, 0.71; 95% CI, 0.42 - 1.20; control rate, 4.93 per 1000 patient-days [95% CI, 3.91 - 6.15]).

Despite the discrepancy, the authors consider CHG wipes a simple way to turn a comfort measure into a "powerful infection-control tool," according to a university news release.

"CHG bathing...could be quickly and widely implemented to prevent morbidity and costs associated with bacteremia in this vulnerable population," the authors write.

According to Christopher Johnson, MD, however, the "promising but not compelling" findings do not warrant CHG use in the absence of high infection rates.

"If the infection rate is already extremely low, adding [CHG baths] won't add much, if anything," Dr. Johnson told Medscape Medical News. "However, I think body washing with chlorhexidine would be useful for any [pediatric intensive care unit (PICU)] to consider that finds itself with an increasing number of nosocomial bloodstream infections, especially when the measure is accompanied by other things, such as meticulous hand washing and local site care of central venous lines."

Dr. Johnson is president of Pediatric Intensive Care Associates, PC, in Santa Fe, New Mexico, and PICU medical director of CentraCare Health Systems in St. Cloud, Minnesota. He was not involved in the study.

5000 Children in 10 PICUs

For the study, 10 PICUs in 5 US hospitals were randomly assigned to bathe children daily using either a 2% CHG cloth or standard practices (soap/water or moist washcloth) for 6 months, followed by use of the alternate method for 6 months.

The ITT population consisted of 4947 children, 2525 of whom were assigned to control units and 2422 to the intervention; lack of guardian consent or availability prevented 875 children from participating (PP population, 4072 patients).

In the PP population, 103 children experienced 113 episodes of bacteremia (CHG, 34 patients; control, 79 patients); 132 cases were reported in 121 children overall (CHG, 53 patients; control, 79 patients).

The CHG-linked reduction in bacteremia risk for children with central venous lines mimicked that of the general population (aIRRPP, 0.66; 95% CI, 0.47 - 0.94; aIRRITT, 0.65; 95% CI, 0.44 - 0.95), and the overall data suggest a trend toward decreased mortality (PP, 2.59% and ITT, 3.01% vs controls, 3.49%).

Study limitations include institutional variations in diagnostic criteria and institutional review board rules for notifying caregivers, lack of data on variables such as peripheral catheterization, and lack of blinding to protocol.

The study was supported grants from Sage Products with additional funding from the National Institutes of Health and the National Institute of Allergy and Infectious Diseases. Dr. Milstone and 5 coauthors have received grant support from Sage Products. Dr. Milstone has also received grant support from bioMérieux. One coauthor received grant support from Vioguard, one received grant support from Merck and is on an advisory board for Pfizer and Hospira, and one received grant support from Optimer Pharmaceuticals. The other authors and Dr. Johnson have disclosed no relevant financial relationships. The data were presented in part at the 2011 annual scientific meetings of the Society of Healthcare Epidemiology of America and the Infectious Diseases Society of America.

Lancet. Published online January 28, 2013. Abstract