Bleasdale Susan C, Trick William E, Gonzalez Ines M, Lyles Rosie D, Hayden Mary K, Weinstein Robert A
Department of Medicine (Infectious Diseases), Rush University Medical Center, Chicago, Illinois, USA.
Arch Intern Med. 2007 Oct 22;167(19):2073-9. doi: 10.1001/archinte.167.19.2073.
To determine whether patients bathed daily with chlorhexidine gluconate (CHG) have a lower incidence of primary bloodstream infections (BSIs) compared with patients bathed with soap and water.
The study design was a 52-week, 2-arm, crossover (ie, concurrent control group) clinical trial with intention-to-treat analysis. The study setting was the 22-bed medical intensive care unit (MICU), which comprises 2 geographically separate, similar 11-bed units, of the John H. Stroger Jr (Cook County) Hospital, a 464-bed public teaching hospital in Chicago, Illinois. The study population comprised 836 MICU patients. During the first of 2 study periods (28 weeks), 1 hospital unit was randomly selected to serve as the intervention unit in which patients were bathed daily with 2% CHG-impregnated washcloths (Sage 2% CHG cloths; Sage Products Inc, Cary, Illinois); patients in the concurrent control unit were bathed daily with soap and water. After a 2-week wash-out period at the end of the first period, cleansing methods were crossed over for 24 more weeks. Main outcome measures included incidences of primary BSIs and clinical (culture-negative) sepsis (primary outcomes) and incidences of other infections (secondary outcomes).
Patients in the CHG intervention arm were significantly less likely to acquire a primary BSI (4.1 vs 10.4 infections per 1000 patient days; incidence difference, 6.3 [95% confidence interval, 1.2-11.0). The incidences of other infections, including clinical sepsis, were similar between the units. Protection against primary BSI by CHG cleansing was apparent after 5 or more days in the MICU.
Daily cleansing of MICU patients with CHG-impregnated cloths is a simple, effective strategy to decrease the rate of primary BSIs.
确定与使用肥皂和水沐浴的患者相比，每天使用葡萄糖酸氯己定（CHG）沐浴的患者原发性血流感染（BSI）的发生率是否更低。
本研究设计为一项为期52周、双臂、交叉（即同期对照组）的临床试验，并进行意向性分析。研究地点为约翰·H·斯特罗格 Jr（库克县）医院的22张床位的医学重症监护病房（MICU），该医院位于伊利诺伊州芝加哥，是一家拥有464张床位的公立教学医院，MICU由两个地理位置分开、类似的11张床位的单元组成。研究人群包括836名MICU患者。在两个研究期的第一个阶段（28周），随机选择1个医院单元作为干预单元，该单元的患者每天使用浸有2%CHG的 washcloths（Sage 2%CHG cloths；Sage Products Inc，伊利诺伊州卡里）沐浴；同期对照单元的患者每天使用肥皂和水沐浴。在第一个阶段结束时经过2周的洗脱期后，清洁方法再交叉使用24周。主要结局指标包括原发性BSI和临床（血培养阴性）脓毒症的发生率（主要结局）以及其他感染的发生率（次要结局）。
CHG干预组的患者发生原发性BSI的可能性显著降低（每1000患者日4.1例感染 vs 10.4例感染；发生率差异为6.3[95%置信区间，1.2 - 11.0]）。各单元之间其他感染（包括临床脓毒症）的发生率相似。在MICU中，使用CHG清洁5天或更长时间后，对原发性BSI的防护作用明显。
每天用浸有CHG的布清洁MICU患者是降低原发性BSI发生率的一种简单、有效的策略。
