Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients

Objective: To demonstrate whether daily bathing with cloths impregnated with 2% chlorhexidine gluconate will decrease colonization of resistant bacteria and reduce the rates of health care-associated infections in critically injured patients. Design: Retrospective analysis of data collected 6 months before and after institution of a chlorhexidine bathing protocol. Setting: A 12-bed intensive care unit in a level I trauma center. Patients: Two hundred eighty-six severely injured patients underwent daily chlorhexidine bathing during the 6-month intervention; 253 patients were bathed without chlorhexidine prior to the intervention. Interventions: Daily chlorhexidine bathing. Main Outcomes Measures: Rates of ventilator-associated pneumonia (VAP), bloodstream infection, and colonization with resistant organisms (methicillinresistant Staphylococcus aureus [MRSA] or Acinetobacter species). Results: Baseline patient and injury characteristics were similar between cohorts. Patients receiving chlorhexidine bathsweresignificantlylesslikelytoacquireacatheter- related bloodstream infection than comparators (2.1 vs 8.4 infections per 1000 catheter-days, P=.01). The incidence of VAP was not affected by chlorhexidine baths (16.9 vs 21.6 infections per 1000 ventilator-days in those with vs those without chlorhexidine baths, respectively, P=. 30). However, patients who received chlorhexidine baths were less likely to develop MRSA VAP (1.6 vs 5.7 infections per 1000 ventilator-days, P=. 03). The rate of colonization with MRSA (23.3 vs 69.3 per 1000 patient-days, P<.001) and Acinetobacter (1.0 vs 4.6 per 1000 patient-days, P=.36) was significantly lower in the chlorhexidine group than in the comparison group. Conclusions: Daily bathing of trauma patients with cloths impregnated with 2% chlorhexidine gluconate is associated with a decreased rate of colonization by MRSA and Acinetobacter and lower rates of catheter-related bloodstream infection and MRSA VAP.