Effect of daily chlorhexidine bathing on hospital-acquired infection.
Effect of daily chlorhexidine bathing on hospital-acquired infection.
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DOI：
10.1056/nejmoa1113849
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发表时间：
2013-02-07
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影响因子：
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通讯作者：
Wong ES
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作者：
Climo MW;Yokoe DS;Warren DK;Perl TM;Bolon M;Herwaldt LA;Weinstein RA;Sepkowitz KA;Jernigan JA;Sanogo K;Wong ES
先前的单中心观察性研究结果表明，患者每日洗必泰洗澡可预防医院获得性血流感染（HABSI）和获得多药耐药微生物（MDRO）。我们进行了一项多中心、随机分组、非盲交叉试验，以评估每天用氯己定浸渍的毛巾洗澡对MDRO获得和HABSI发生率的影响。6家医院的9个重症监护和骨髓移植单位被随机分配给患者使用2%氯己定浸渍的免冲洗或非抗菌毛巾洗澡，为期6个月，在随后的6个月内更换为替代产品。采用Poisson回归分析比较两个时间段MDRO发生率和HABSI发生率。研究期间共入组7735例患者。使用洗必泰洗浴时的总体MDRO获得率（5.10例/1000患者日）比使用非抗菌毛巾时（6.60例/1000患者日，p=0.028）低21%。使用洗必泰时的总体HABSI发生率（4.45例/1000患者日）比使用非抗菌布时（6.60例/1000患者日，p=0.007）低31%。每天用洗必泰浸渍的毛巾洗澡显著降低了获得MDRO和发展HABSI的风险。
Results of previous single center observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections (HABSIs) and acquisition of multidrug-resistant organisms (MDROs). We conducted a multicenter, cluster randomized, non-blinded crossover trial to evaluate the effect of daily bathing with chlorhexidine impregnated washcloths on the acquisition of MDROs and incidence of HABSIs. Nine intensive care and bone marrow transplant units in 6 hospitals were randomly assigned to bathe patients with either 2% no-rinse chlorhexidine-impregnated or non-antimicrobial washcloths for a six-month period, exchanged for the alternate product during the subsequent six months. The incidence rates of acquisition of MDRO and HABSI rates were compared between the two time periods by Poisson regression analysis. A total of 7735 patients were enrolled during the study. The overall MDRO acquisition rate was 21% lower when chlorhexidine bathing was used (5.10 cases per 1000 patient days) than when non-antimicrobial washcloths were used (6.60 cases per 1000 patient days, p=0.028). The overall HABSI rate was 31% lower when chlorhexidine was used (4.45 cases per 1000 patient days) than when non-antimicrobial cloths were used (6.60 cases per 1000 patient days, p=0.007) No serious skin reactions were noted in either study period. Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risk of acquiring MDROs and developing HABSI.