Noto m j domenico h j byrre m stalbot t rice t w

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Noto, M. J., Domenico, H. J., Byrre, M. S.,Talbot, T., Rice, T. W., Bernard, G. & Wheeler, A. P. (2015). Chlorhexidine bathing and health care associated infections: A randomized clinical trial. JAMA, 313(4), 369-378. doi:10.1001/jama.2014.18400. Retrieved from 7
PICOT STATEMENT AND LITERATURE SEARCHAbstractImportance: Daily bathing of critically ill patients with the broad-spectrum, topical antimicrobial agent chlorhexidine is widely performed and may reduce health care–associated infections. Objective: To determine if daily bathing of critically ill patients with chlorhexidine decreases the incidence of health care–associated infections. Design, Setting, and Participants: A pragmatic clusterrandomized, crossover study of 9340 patients admitted to 5 adult intensive care units of a tertiary medical center in Nashville, Tennessee, from July 2012 through July 2013. Interventions: Units performed once-daily bathing of all patients with disposable cloths impregnated with 2% chlorhexidine or non-antimicrobial cloths as a control. Bathing treatments were performed for a 10-week period followed by a 2-week washout period during which patients were bathed with non-antimicrobial disposable cloths, before crossover to the alternate bathing treatment for 10 weeks. Each unit crossed over between bathing assignments 3 times during the study. Main Outcomes and Measures: The primary pre-specified outcome was a composite of central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated pneumonia (VAP), and Clostridium difficileinfections. Secondary outcomes included rates of clinical cultures that tested positive for multidrug-resistant organisms, blood culture contamination, health care–associated bloodstream infections, and rates of the primary outcome by ICU. Results: During the chlorhexidine bathing period, 55 infections occurred: 4 CLABSI, 21 CAUTI, 17 VAP, and 13 C difficile. During the control bathing period, 60 infections occurred: 4 CLABSI, 32 CAUTI, 8 VAP, and 16 C difficile. The primary outcome rate was 2.86 per 1000 patient-days during the chlorhexidine and 2.90 per 1000 patient-days during the control bathing periods (ratedifference, −0.04; 95% CI, −1.10 to 1.01; P= .95). After adjusting for baseline variables, no difference between groups in the rate of the primary outcome was detected. Chlorhexidine bathing did not change rates of infection-related secondary outcomes including hospital-acquired 8
PICOT STATEMENT AND LITERATURE SEARCHbloodstream infections, blood culture contamination, or clinical cultures yielding multidrug-resistant organisms. In a pre-specified subgroup analysis, no difference in the primary outcome was detected in any individual intensive care unit. Conclusion and Relevance: In this pragmatic trial, daily bathing with chlorhexidine did not reduce the incidence of health care–associated infections including CLABSIs, CAUTIs, VAP, or C difficile. These findings do not support daily bathing of critically ill patients with chlorhexidine.9

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