Dr Thiago Silva1,2, Jessica Shults1,2,3, Sally Havers1,2,3,4, Josephine Lovegrove1,2, Niccolò Buetti5,6, Bertrand Drugeon7,8, Bruno Dantas9, Aline Bitencourt9, Isadora de Souza9, Eoin O’Sullivan10, Jane Wickins11, Jue (Jenny) Wang11, Andrea Henden12, Patricia Rocha2,9, Claire Rickard1,2,3,13
1School of Nursing, Midwifery and Social Work, Frazer Institute, University of Queensland, , Australia, 2Alliance for Vascular Access Teaching and Research, Griffith University, , Australia, 3Herston Infectious Diseases Institute, Metro North Health, Queensland, , Australia, 4Darling Downs Health, Toowoomba, , Australia, 5Infection Control Program and WHO Collaborating Centre,Geneva University Hospitals, Faculty of Medicine, , Switzerland, 6Université Paris-Cité, INSERM, IAME UMR 1137, , France, 7CHU de Poitiers, Service des Urgences Adultes – SAS 86 – SAMU, 2 rue de la Milétrie, , France, 8Faculté de Médecine et de Pharmacie, Université de Poitiers, , France, 9Universidade Federal de Santa Catarina, , Brazil, 10Kidney Health Service, Metro North, , Australia, 11Metro North Kidney Health Service, , Australia, 12Haematology; Clinical Haematology Referral Centre for Metro North and Central Queensland RBWH, , Australia, 13Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, , Australia
Biography:
Thiago Silva is a Postdoctoral Research Fellow at The University of Queensland’s Infection Prevention and Vascular Access Group. His research focuses on vascular access, patient safety, healthcare-associated infections, and implementation science.
Abstract:
Introduction
Evidence supporting chlorhexidine (CHG) bathing for central line-associated bloodstream infection (CLABSI) prevention in intensive care units is robust, but uncertainty remains in other settings. We aimed to evaluate the effect of CHG bathing on CLABSI in non-ICU settings.
Methods
Systematic review with meta-analysis. Studies evaluating repeated CHG bathing, including primary studies, conference abstracts, and clinical trial registrations, were eligible without language or date restrictions. Two reviewers independently conducted study selection and full-text assessment. Quality assessment and meta-analysis are ongoing.
Results
26 studies were included (7,199 patients; 6,010 received CHG bathing). 12 research papers, 13 conference abstracts, and 1 clinical trial registration. Most were quality improvement (n=13) or pre-post quasi-experimental (n=8). Settings included haematology/oncology, transplant, medical/surgical wards, long-term care, and haemodialysis. Twelve studies (46%) did not specify CHG bathing method, 10 (39%) used 2% CHG-impregnated cloths, and 4 (15%) used 4% CHG solution. Nine (35%) reported adverse events, mostly mild skin reactions. CLABSI metrics were inconsistent across studies. Three studies (11.5%) provided comparative incidence data: CLABSI occurred in 42/212 (19.8%) CHG and 43/204 (21.1%) non-CHG patients. Thirteen studies (50%) reported CLABSI per 1,000 catheter-days, with mean rates of 1.90 ± 1.36 (CHG) and 2.93 ± 2.16 (non-CHG). Five studies (19.2%) reported CLABSI per 1,000 patient-days, with mean rates of 3.66 ± 2.59 (CHG) and 7.45 ± 6.49 (non-CHG). CHG was associated with significantly lower CLABSI in 9 (35%) studies and significantly higher in one (4%); 6 (23%) provided insufficient comparative data.
Conclusion
CHG bathing was generally associated with lower CLABSI rates in non-ICU settings. Adequately sized high-quality RCTs are needed.