Hospital‐acquired methicillin‐resistant Staphylococcus aureus (HA‐MRSA) infections annually affect almost 21,000 patients nationwide. Randomized controlled trials have demonstrated the efficacy of chlorhexidine gluconate (CHG) in preventing HA‐MRSA infections associated with invasive procedures. Several small studies involving CHG baths in the intensive care unit (ICU) have demonstrated a reduction in HA‐MRSA colonization and bacteremia. However, the efficacy of CHG bathing on all inpatients, including those outside the ICU, in preventing clinically significant HA‐MRSA infections remains unproven. The objective of this study was to evaluate the effectiveness of a CHG bath protocol on admission in reducing the incidence of HA‐MRSA infection in all adult hospitalized patients.
A retrospective cohort analysis of HA‐MRSA infections in adult inpatients was performed in a community hospital before and after initiating a protocol in which all patients were to receive a full body CHG bath on admission. HA‐MRSA infection was defined by CDC criteria and positive pertinent cultures. Comparisons were made between a preintervention control group, June through November 2008, and a postintervention group, June through November 2009. Statistical comparisons of categorical variables were performed using the chi‐square or Fisher's exact test, as appropriate. The protocol was initiated in December 2008, but similar calendar months were compared in our study to account for seasonal variation. The study was powered to detect a 50% reduction in HA‐MRSA infection with 95% sensitivity.
Forty‐eight patients (0.21%) of 23,194 admissions developed HA‐MRSA infections during the study period. In the preimplementation control group, 20 patients (0.18%) of 11,373 admissions developed HA‐MRSA infection; this compares to 26 (0.22%) of 11,821 after protocol implementation (P < 0.67). Of the HA‐MRSA infections, there was a statistically significant increase in the incidence of HA‐MRSA pneumonia (P < 0.021) in the post‐intervention group; but no statistically significant change in the incidence of sepsis, surgical/wound infections, or urinary tract infections. The CHG bath protocol was discontinued for lack of efficacy and potential for harm.
Our intention‐to‐treat analysis suggests that a hospital‐wide protocol to administer full body CHG baths on admission does not reduce the incidence of HA‐MRSA infections. Furthermore, the increase in HA‐MRSA pneumonia in the postintervention group—with a plausible relationship to the initiation of the CHG protocol—is especially concerning. Variables possibly contributing to the increasing trend in HA‐MRSA pneumonia include an increase in MRSA surveillance and/or the development of CHG resistance. This is the first study to our knowledge examining the efficacy of a hospital‐wide CHG bath protocol on the incidence of HA‐MRSA infections. Before implementing similar hospital‐wide CHG bath protocols, further studies are warranted.
J. Cohen ‐ none; A. Silwal ‐ none; R. Shah ‐ none; T. Lane ‐ none
To cite this abstract:Cohen J, Silwal A, Shah R, Lane T. Failure of a Hospital‐Wide Chlorhexidine Bath Admission Protocol in Preventing Hospital‐Acquired Methicillin‐Resistant Staphylococcus Aureus Infection. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 1005. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/failure-of-a-hospitalwide-chlorhexidine-bath-admission-protocol-in-preventing-hospitalacquired-methicillinresistant-staphylococcus-aureus-infection/. Accessed April 1, 2020.