Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review

SummaryBackgroundThe topical use of chlorhexidine gluconate (CHG) is intended to reduce bacterial density on patients' skin.AimTo assess the impact of body bath or skin cleansing with CHG-impregnated or CHG-saturated washcloths in preventing healthcare-associated infections and colonization.MethodsThis systematic review included published randomized controlled trials, cross-over trials, cohort studies and before-and-after studies. Studies were included if they compared the use of CHG in washcloths with any of the following; soap and water bathing, routine advice, no intervention.FindingsSixteen published studies and four conference abstracts were included for systematic review. Nine studies reported the impact of CHG on incidence of central-line-associated bloodstream infection (CLABSI); the incidence rate ratio (IRR) was 0.43 [95% confidence interval (CI): 0.26–0.71]. Five studies assessed the impact of CHG washcloths on incidence of surgical site infection (SSI); the RR was 0.29 (95% CI: 0.17–0.49). Four studies reported the impact on vancomycin-resistant enterococci (VRE) colonization; the IRR was 0.43 (95% CI: 0.32–0.59). Three studies reported the impact on meticillin-resistant Staphylococcus aureus (MRSA) colonization rate; the IRR was 0.48 (95% CI: 0.24–0.95). Six studies reported the impact on VRE infection; the IRR was 0.90 (95% CI: 0.42–1.93). Six studies reported the impact on MRSA infection; the IRR was 0.82 (95% CI: 0.51–1.30). There was no reduction in acinetobacter infection rates in the three studies where this was reported.ConclusionThese results suggest that the use of non-rinse CHG application significantly reduces the risk of CLABSI, SSI and colonization with VRE or MRSA, but not infection.