The Efficacy of Daily Bathing with Chlorhexidine for Reducing Healthcare-Associated Bloodstream Infections: A Meta-analysis
The Efficacy of Daily Bathing with Chlorhexidine for Reducing Healthcare-Associated Bloodstream Infections: A Meta-analysis
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DOI：
10.1086/664496
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发表时间：
2012-03-01
影响因子：
4.5
通讯作者：
Safdar, Nasia
中科院分区：
文献类型：
--
作者：
O'Horo, John C.;Silva, Germana L. M.;Safdar, Nasia
设计随机对照试验和准实验研究的系统综述和荟萃分析，以评估每日洗必泰（CHG）洗澡预防医疗保健相关血流感染（BSI）的有效性。内科、外科、创伤和内外科联合重症监护室（ICU）和长期急性护理医院。Inpatients.METHODS.提取了患者人群、BSI诊断标准、局部CHG的形式和浓度、BSI发生率和研究设计的数据。1项随机对照试验和11项非随机对照试验共报告了137，392患者-天，符合入选标准; CHG组有291例患者在67，775患者-天内发生BSI，而对照组有557例患者在69，617导管-天内发生BSI。CHG沐浴导致BSI发生率降低：使用随机效应模型的合并比值比为0.44（95%置信区间，0.33-0.59; P < .00001）。统计异质性为中度，I-2为58%。对于检查中心线相关BSI的研究亚组，比值比为0.40（95%置信区间，0.27-0.59）。在内科ICU患者中，每日用CHG洗澡可降低BSI的发生率，包括中心静脉导管相关的BSI。建议进一步研究以确定CHG的最佳频率、应用方法和浓度，以及该策略相对于其他可用于减少BSI的预防措施的相对有效性。未来的研究还应检查每日CHG沐浴在非ICU人群中的BSI风险的有效性。
DESIGN. Systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies to assess the efficacy of daily bathing with chlorhexidine (CHG) for prevention of healthcare-associated bloodstream infections (BSIs).SETTING. Medical, surgical, trauma, and combined medical-surgical intensive care units (ICUs) and long-term acute care hospitals.PARTICIPANTS. Inpatients.METHODS. Data on patient population, diagnostic criteria for BSIs, form and concentration of topical CHG, incidence of BSIs, and study design were extracted.RESULTS. One randomized controlled trial and 11 nonrandomized controlled trials reporting a total of 137,392 patient-days met the inclusion criteria; 291 patients in the CHG arm developed a BSI over 67,775 patient-days, compared with 557 patients in the control arm over 69,617 catheter-days. CHG bathing resulted in a reduced incidence of BSIs: the pooled odds ratio using a random-effects model was 0.44 (95% confidence interval, 0.33-0.59; P < .00001). Statistical heterogeneity was moderate, with an I-2 of 58%. For the subgroup of studies that examined central line-associated BSIs, the odds ratio was 0.40 (95% confidence interval, 0.27-0.59).CONCLUSIONS. Daily bathing with CHG reduced the incidence of BSIs, including central line-associated BSIs, among patients in the medical ICU. Further studies are recommended to determine the optimal frequency, method of application, and concentration of CHG as well as the comparative effectiveness of this strategy relative to other preventive measures available for reducing BSIs. Future studies should also examine the efficacy of daily CHG bathing in non-ICU populations at risk for BSI.