Prospective, crossover, comparative study of two methods of chlorhexidine bathing

TL;DR

A study compared two methods of chlorhexidine bathing in ICU patients and found that both reduced skin bacteria, with 2% cloths being more effective.

Contribution

The study provides a direct comparison of two chlorhexidine bathing methods in ICU settings.

Findings

2% CHG-impregnated cloths reduced microbial colonization more effectively than 4% CHG solution.

Both methods significantly decreased microbial colonization compared to no CHG bathing.

2% cloths resulted in higher CHG skin concentration and lower bacterial counts.

Abstract

Bathing intensive care unit (ICU) patients with chlorhexidine gluconate (CHG) decreases healthcare-associated infections (HAIs). The optimal method of CHG bathing remains undefined.

Prospective crossover study comparing CHG daily bathing with 2% CHG-impregnated cloths versus 4% CHG solution. In phase 1, from January 2020 through March 2020, 1 ICU utilized 2% cloths, while the other ICU utilized 4% solution. After an interruption caused by the coronavirus disease 2019 pandemic, in phase 2, from July 2020 through September 2020, the unit CHG bathing assignments were reversed. Swabs were performed 3 times weekly from patients’ arms and legs to measure skin microbial colonization and CHG concentration. Other outcomes included HAIs, adverse reactions, and skin tolerability.

411 assessments occurred after baths with 2% cloth, and 425 assessments occurred after baths with 4% solution. Average microbial colonization was 691 (interquartile range 0, 30) colony-forming units per square centimeter (CFU/cm2) for patients bathed with 2% cloths, 1,627 (0, 265) CFUs/cm2 for 4% solution, and 8,519 (10, 1130) CFUs/cm2 for patients who did not have a CHG bath (P < .001). Average CHG skin concentration (parts per million) was 1300.4 (100, 2000) for 2% cloths, 307.2 (30, 200) for 4% solution, and 32.8 (0, 20) for patients without a recorded CHG bath. Both CHG bathing methods were well tolerated. Although underpowered, no difference in HAI was noted between groups.

Either CHG bathing method resulted in a significant decrease in microbial skin colonization with a greater CHG concentration and fewer organisms associated with 2% CHG cloths.

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