Effect of daily bathing with chlorhexidine on hospital-acquired bloodstream infection in critically ill patients: a meta-analysis of randomized controlled trials

Introduction

Whole-body skin decolonization with chlorhexidine in critically ill patients reduces multidrug-resistant bacterial colonization, and catheter-related bloodstream infection (BSI). We performed a meta-analysis of randomized controlled trials to determine whether daily bathing with chlorhexidine decreased hospital-acquired BSIs in critically ill patients.

Methods

We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases to identify randomized controlled trials that compared daily bathing with chlorhexidine and a control (daily bathing with soap and water or nonantimicrobial washcloths, or implementation of MRSA screening and isolation) in critically ill patients. The primary outcome was hospital-acquired BSIs. Secondary outcomes were adverse effects of chlorhexidine and the incidence of identified pathogens.

Results

This meta-analysis included four studies. The overall incidence of hospital-acquired BSIs was significantly lower in the chlorhexidine group compared with the control 0.80 (95% CI, 0.71 to 0.90; P < 0.001; I² = 29.4%). Gram-positive (RR = 0.59, 95% CI, 0.44 to 0.79, P = 0.000; I² = 46.0%) and MRSA-induced (pooled RR = 0.64; 95% CI, 0.47 to 0.88, P = 0.006; I² = 0.0%) bacteremias were significantly less common in the chlorhexidine group. Chlorhexidine did not affect Gram-negative bacteremia or fungemia. The overall incidence of adverse events, such as skin rashes, was similar in both groups.

Conclusion

Daily bathing with chlorhexidine was associated with a reduction in the rates of hospital-acquired BSI without significant complications in critically ill patients. It also decreased the incidence of Gram-positive hospital-acquired BSIs, especially MRSA.