A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units
A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units
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DOI：
10.1017/ice.2016.23
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发表时间：
2016-07-01
影响因子：
4.5
通讯作者：
Anderson, Deverick J.
中科院分区：
文献类型：
--
作者：
Dicks, Kristen V.;Lofgren, Eric;Anderson, Deverick J.
目标。为了确定重症监护病房(ICU)患者每天洗氯己定(CHG)是否导致医院获得性感染(HAI)的减少，特别是由耐甲氧西林金黄色葡萄球菌(MRSA)和万古霉素耐药肠球菌(VRE)引起的感染。设计中断的时间序列分析。集合。这项研究包括33家社区医院，从2008年1月到2013年12月，参与Duke感染控制外联网络的33家医院。主要预先指定的结果包括ICU中心线相关血流感染(CLABSI)、原发血流感染(BSI)、呼吸机相关肺炎(VAP)和导管相关尿路感染(CAUTIs)。结果：洗澡与ICU CLABSI(发病率比0.96；95%可信区间0.93~0.99)、ICU原发BSI(IRR 0.96；95%CI，0.94~0.99)、VRE CLABSI(IRR 0.97；95%CI，0.97~0.98)和所有VRE合并感染(IRR，0.96；95%CI，0.93~1.00)的发生率呈显著下降趋势。在实施CHG洗澡前后，MRSA感染率没有发现明显的趋势。结论：在这项对CHG洗澡影响的多中心真实世界分析中，实施CHG洗澡的医院实现了ICU CLABSI、ICU初级BSIS和VRE CLABSI的下降。CHG洗澡不影响因MRSA而引起的特定或总体感染率。我们的发现支持ICU患者每天进行CHG洗澡。
OBJECTIVE. To determine whether daily chlorhexidine gluconate (CHG) bathing of intensive care unit (ICU) patients leads to a decrease in hospital-acquired infections (HAIs), particularly infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE).DESIGN. Interrupted time series analysis.SETTING. The study included 33 community hospitals participating in the Duke Infection Control Outreach Network from January 2008 through December 2013.PARTICIPANTS. All ICU patients at study hospitals during the study period.METHODS. Of the 33 hospitals, 17 hospitals implemented CHG bathing during the study period, and 16 hospitals that did not perform CHG bathing served as controls. Primary pre-specified outcomes included ICU central-line associated bloodstream infections (CLABSIs), primary bloodstream infections (BSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTIs). MRSA and VRE HAIs were also evaluated.RESULTS. Chlorhexidine gluconate (CHG) bathing was associated with a significant downward trend in incidence rates of ICU CLABSI (incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.93-0.99), ICU primary BSI (IRR, 0.96; 95% CI, 0.94-0.99), VRE CLABSIs (IRR, 0.97; 95% CI, 0.97-0.98), and all combined VRE infections (IRR, 0.96; 95% CI, 0.93-1.00). No significant trend in MRSA infection incidence rates was identified prior to or following the implementation of CHG bathing.CONCLUSIONS. In this multicenter, real-world analysis of the impact of CHG bathing, hospitals that implemented CHG bathing attained a decrease in ICU CLABSIs, ICU primary BSIs, and VRE CLABSIs. CHG bathing did not affect rates of specific or overall infections due to MRSA. Our findings support daily CHG bathing of ICU patients.