Trial Information

The Impact of the Use of Chlorhexidine-Based Bathing System in the Hospital to Reduce the Incidence of MRSA/VRE Infection or Colonization and Nosocomial Bloodstream Infections (BSI)

Infections due to Staphylococci including MRSA are the predominant nosocomially acquired
complication in the intensive care unit. The increasing incidence of MRSA colonization and
infection among ICU patients has been attributed to many factors including increased
admission of patients already colonized with MRSA to the ICU, poor compliance with
handwashing and barrier precautions, delayed identification of MRSA colonized patients, and
understaffing. Measures that have proven to limit horizontal transmission between patients
and staff and staff to patients include strict attention to barrier precautions and
handwashing. Unfortunately both of these strategies require levels of compliance that are
often not achieved.

Nosocomial blood stream infections are a leading source of morbidity and mortality among
intensive care unit patients. Several modifiable factors have been shown to increase the
risk of bloodstream infections. These include lapses in the use of strict sterile technique
in the insertion of central venous catheters and improper site preparation. New CDC
guidelines on the prevention of catheter related bloodstream infections recommend that the
preferential use of chlorhexidine containing skin disinfectants be used for site preparation
prior to insertion. The use of chlorhexidine reduces residual skin organisms as well as
inhibits their rebound growth and has been demonstrated to reduce catheter-associated
bloodstream infections in comparison to other skin disinfectant products such as
povidone-iodine.

As a result of guidelines promoting the use of chlorhexidine, a number of intensive care
units have implemented quality improvement projects examining the potential role of
chlorhexidine based bathing of intensive care unit patients in reducing nosocomial
transmission of multiresisitant organisms such as MRSA and vancomycin-resistant enterocooci
(VRE). The goal of the currently proposed study is to analyse existing data from
participating intensive care units that have adopted the use of chlorhexidine antisepsis to
determine the impact of chlorhexidine on bacterial colonization and nosocomial infections
Participating hospitals who have completed quality improvement projects that included the
use of chlorhexidine in bathing of ICU patients will submit de-identified data on nosocomial
bacteremias and MRSA and VRE colonization during defined time periods where chlorhexidine
bathing was used in comparison to time periods where regular bathing procedures were
utilized.