Infection Prevention and Control Department, Westchester Medical Center, Valhalla, New York 10595, USA.
Am J Med. 2012 May;125(5):505-11. doi: 10.1016/j.amjmed.2011.10.032.
Chlorhexidine bathing has been associated with reductions in healthcare-associated bloodstream infection. To determine the impact and sustainability of the effect of chlorhexidine bathing on central venous catheter-associated bloodstream infection, we performed a prospective, 3-phase, multiple-hospital study.
In the medical intensive care unit and the respiratory care unit of a tertiary care hospital and the medical-surgical intensive care units of 4 community hospitals, rates of central venous catheter-associated bloodstream infection were collected prospectively for each period. Pre-intervention (phase 1) patients were bathed with soap and water or nonmedicated bathing cloths; active intervention (phase 2) patients were bathed with 2% chlorhexidine gluconate cloths with the number of baths administered and skin tolerability assessed; post-intervention (phase 3) chlorhexidine bathing was continued but without oversight by research personnel. Central venous catheter-associated bloodstream infection rates were compared over study periods using Poisson regression.
Compared with pre-intervention, during active intervention there were significantly fewer central venous catheter-associated bloodstream infections (6.4/1000 central venous catheter days vs 2.6/1000 central venous catheter days, relative risk, 0.42; 95% confidence interval, 0.25-0.68; P<.001), and this reduction was sustained during post-intervention (2.9/1000 central venous catheter days; relative risk, 0.46; 95% confidence interval, 0.30-0.70; P<.001). During the active intervention period, compliance with chlorhexidine bathing was 82%. Few adverse events were observed.
In this multiple-hospital study, chlorhexidine bathing was associated with significant reductions in central venous catheter-associated bloodstream infection, and these reductions were sustained post-intervention when chlorhexidine bathing was unmonitored. Chlorhexidine bathing was well tolerated and is a useful adjunct to reduce central venous catheter-associated bloodstream infection.
洗必泰沐浴与降低医疗保健相关的血流感染有关。为了确定洗必泰沐浴对中心静脉导管相关血流感染的影响和可持续性，我们进行了一项前瞻性、3 期、多医院研究。
在一家三级保健医院的内科重症监护病房和呼吸护理病房以及 4 家社区医院的内科-外科重症监护病房，前瞻性地收集每个时期的中心静脉导管相关血流感染率。在干预前（第 1 阶段），患者用肥皂和水或非药用沐浴布洗澡；在积极干预（第 2 阶段）期间，患者用 2%葡萄糖酸氯己定布洗澡，评估洗澡次数和皮肤耐受性；在干预后（第 3 阶段）继续进行洗必泰沐浴，但不进行研究人员监督。使用泊松回归比较研究期间的中心静脉导管相关血流感染率。
与干预前相比，在积极干预期间，中心静脉导管相关血流感染明显减少（6.4/1000 中心静脉导管日与 2.6/1000 中心静脉导管日，相对风险，0.42；95%置信区间，0.25-0.68；P<.001），并且在干预后仍保持持续（2.9/1000 中心静脉导管日；相对风险，0.46；95%置信区间，0.30-0.70；P<.001）。在积极干预期间，洗必泰沐浴的依从性为 82%。观察到的不良事件很少。
在这项多医院研究中，洗必泰沐浴与中心静脉导管相关血流感染的显著减少相关，并且在干预后未监测洗必泰沐浴时，这些减少仍然持续。洗必泰沐浴耐受性良好，是减少中心静脉导管相关血流感染的有用辅助手段。
