Summary Table for Research Critique

Citation Purpose and Research Question Research the effectiveness of Chlorhexidine bathing versus soap and water bathing to reduce catheterassociated bloodstream infections in medical intensive care unit patients. Is Chlorhexidine more effective than soap and water to reduce blood stream infections in patients in the MICU? Research Design Level of evidence Randomized control Trial and Crossover design. Level 2 evidence. Sample 836 MICU patients in a 464-bed hospital. Variables and Measures Incidences in primary bloodstream infections, clinical sepsis, and incidences of other infections. Included a control group and an intervention group; one group received bathing with soap and water while the intervention group was washed with the CHG cloths. There was a two week washout period in between the crossover, where the groups were then switched. Measurement was analyzed by physicians who assessed for infection. Two antiseptic groups were formed and during the trial catheters that would remain in place for 3 or more days were eligible for the study. Catheters Statistical Tests Probability with a 95% confidence interval. Multivariable Poisson and negative binomial regression models. Two variable nominal analysis comparing patients bathed with either soap and water or Chlorhexidine cloths. Results Patients in the CHG intervention arm were significantly less likely to acquire a primary blood stream infection. There was a decrease found in patients bathed with the CHG cloths by 61%. Summary Statements for Practice The use of CHG cloths can reduce infections in patients who are critically ill and in the medical intensive care unit. The patients who were washed with the CHG cloths had delayed mortality due to reduced risk of infection.

Bleasdale, S.C., Trick, W.E., Gonzalez, I.N., Lyles, R.D., Hayden, M.K., Weinstein, R.A. (2007). Effectiveness of Chlorhexidine Bathing to Reduce CatheterAssociated Bloodstream Infections in Medical Intensive Care Unit Patients. Arch Intern Med. 167(19):20732079.

Mimoz, O., Villeminey, S., Ragot, S., Dahyot-Fizelier, C., Laksiri, L., Petitpas, F., Debaene, B. (2007). Chlorhexidine-

Discover if there is a more effective way to care for central venous catheters and reduce the risk of infection using Chlorhexidine antiseptic vs.

Randomized control trial, level 2 of evidence.

538 catheters randomized, 481 produced evaluable culture results.

Cox proportional hazards model with a 95% confidence interval was used to estimate relative risk. Two variable nominal analysis between patients who had

This study showed a 50% decrease in the incidence of catheter colonization, and lower rates of catheter-related bloodstream infection.

Chlorhexidine solutions should be used as a replacement for povidone iodine to prevent catheter related infection and ultimately decrease on

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Based Antiseptic Solution vs Alcohol-Based Povidone-Iodine for Central Venous Catheter Care. Arch Intern Med. 167(19):20662072
Povidone Iodine. Should Chlorhexidine based antiseptic solution be used instead of alcohol based povidone iodine for central venous catheter care? were inserted and dressing changes were either 5% povidone iodine in 70% ethanol or 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzylic alcohol. Physicians did not know what solution they were using and the blood was cultured for aerobic and anaerobic bacteria when patient had a fever and immediately after catheter removal. When a patient had coagulasenegative staphylococci bacteremia, 2 cultures with positive results obtained from separate blood samples were mandatory. o Number of catheter days o Blood cultures chlorhexidine antiseptic and povidone iodine antiseptic. patient length of stay, and cost.

Heiner, R., Franke, M., Gastmeier, P., Zenz, S., Mahr, K., Buchholz, S., Hertenstien, B., Hecker, H., &

The purpose of this study was to evaluate the effectiveness of chlorhexidineimpregnated

Randomized control trial Research level two

601 patients from two high dependency units at a university hospital

Relative risks Confidence interval

19 cases in the control 34 cases in the test group

Chlorhexidine impregnated sponges dressings significantly reduce the risk of

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Piepenbrock, S. (2008). Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings:a randomized control trial . doi: 10.1007/s00277008-0568-7 Ramritu, P., Halton, K., Cook, D., Whitby, M., & Graves, N. (2008). Catheter related bloodstream infections in intensive care units: a systematic review with metaanalysis. Journal of Advanced Nursing, 62(1), 321. doi: 10.1111/j.13652648.2007.04564. x Munoz-Price, L., Hota, B., Stemer, A., & Weinstein, R. (2009). Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care sponges for reducing catheter related infections of central venous catheters inserted for chemotherapy undergoing chemotherapy

o o o o

Comorbiditie s Nursing care Unblinded nurses Randomized, prospective, open, controlled clinical study Relative risks

CRIs in patients at high risk for infection.

o
Analyze the methods used to reduce catheter related infections in intensive care patients other than antimicrobacterial coated catheters Systematic review with meta-analysis Level one research 23 studies were included in the review

The two reviewers opinion and education Validated information extraction tool Pooling of similar interventions

Confidence interval

A range of interventions may reduce the risks of catheter related blood stream infection Ex: Insertion in subclavian, use of alternate skin prep, vitacuff in combination with polymyxin, bacitracin ointment, staff education and performance feedback The study shows that use with chlorhexidine baths significantly reduces the risk of acquiring a blood stream infection as evidenced by the significant decrease in

A range of interventions may reduce the risks of catheter related blood stream infections

Evaluate the effectiveness of chlorhexidine baths in acute care facilities and how it relates to lowering the susceptibility of the patients to blood stream

QuasiExperimental study; Level III evidence

405 patients at a 70-bed long term acute care hospital

This study consisted of a preintervention period, an intervention period, and a postintervention period. During the preintervention period, the

Poisson regression was used; variables were eliminated using a backward selection approach for variables with P values greater than .15. All analyses were

The use of chlorhexidine for daily bathing greatly reduces the incidence of CLABSIs. Its use will ultimately decrease mortality related to infection, length of stay,

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hospital. Infection Control and Hospital Epidemiology, 30(11), 10311035. infections. experimental group received daily soap-andwater baths. During the intervention period, daily 2% chlorhexidine baths were given .The postintervention period The authors were provided a casemix index, a monthly cumulative acuity index by the institution for the reliability and validity of the instruments. Report of Expert Committee; Level VII evidence Emory University Hospital in Atlanta, Georgia, with 93 ICU beds and 9 specialty ICUs. Compliance was considered all or none. If the bath was not documented or was documented as bath only, it was measured as zero compliance with the process change. Documentation needed to clearly state bath with chlorhexidine in order to count as compliance. performed using SAS, version 9.1 positive blood cultures during the intervention period and cost.

Holder, C., Zellinger, M. (2009). Daily bathing with chlorhexidine in the icu to prevent central line associated bloodstream infections. Journal of Clinical Outcomes Management. 16(11), 509-513.

To describe a quality initiative to reduce central line associated bloodstream infections (BSIs) and acquisition of multidrugresistant organisms by using chlorhexidine wipes for daily bathing of intensive care unit patients.

Not discussed.

BSI rates decreased from 3.6/1000 patient days to 1/1000 patient days 6 months after implementation of the chlorhexidine bath procedure. The rate of MRSA/VRE colonization was 3.6/1000 patient days prior to the implementation of the chlorhexidine daily baths and was reduced to 1/1000 patient days following

The use of chlorhexidine baths reduced BSIs and resistant organism acquisition rates at our hospital. Though the cost per bath increased, savings were seen in staff time, which allowed staff to focus on other areas of patient care. Based on a 75% reduction in BSIs over 6 months,

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implementation. we calculated a projected cost savings of $1.56 million per year if chlorhexidine baths were used in all of our hospital ICUs.

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