Table 1.
Study | Design | Patients included (n) | Duration (months) | Setting | Domaina | CHG intervention | Co-interventions or control group | Primary outcome | Secondary outcome(s) |
---|---|---|---|---|---|---|---|---|---|
Batra [13] | ITS | 4,570 | 51 | Single center, mixed ICU | Patients colonized or infected with MRSA | 1 % CHG in nostrils/mouth/tracheotomy site QID | Educational campaign (reinforcing HH and barrier nursing, covert HH and barrier nursing audit and monthly MRSA infection rate feedback) | Transmission of MRSA colonization | – |
1 % CHA in groin/axillae/skin folds daily | MRSA colonized nursed in side rooms or pairs | ||||||||
4 % CHG body wash daily | |||||||||
Bleasdale [10] | RCT | 836 | 12 | Single center, medical ICU | All patients | 2 % CHG body wash daily with impregnated cloths | Daily bathing with soap and water | All-cause primary BSIs | All-cause UTI, VAP, and secondary BSIs. |
Camus [14] | RCT | 256b | 30 | Multi-center, medical ICUs | Patients with expected duration of ventilation > 48 h | 15 ml of 4 % CHG body wash every 12 h for 5 days with or without SDD | SDD plus “body wash placebo” or placebo only | All-cause infections acquired until 48 h after termination of study treatments | All-cause total and device-related infections |
Climo [15] | ITS | 5,043 | 12 | Multi-center, medical, surgical, cardiac surgery; and coronary/medical ICUs | All patients | 4 % CHG body wash daily | Daily bathing with non-medicated soap and water | Acquisition of MRSA and VRE colonization and BSIs | – |
Gould [16] | ITS | 2,653 | 48 | Single center, mixed ICU | All patients | 4 % CHG body and hair wash daily | Nasal ointment QID (a) 2 % fusidic acid; (b) 3 % oxytetracycline (only available first 6 months) or (c) 0.5 % neomycin sulphate w 0.1 % chlorhexidine hydrochloride | Acquisition of MRSA colonization and infection | S. aureus bacteremia |
Popovich [17] | ITS | 3,048c | 24 | Single center, surgical ICU | All patients | 2 % CHG body wash daily | Daily bathing with bar soap, warm water and cotton washcloths | Acquisition of all-cause CLABSIs | Acquisition of other nosocomial infections |
Raineri [18] | ITS | 3,978 | 120 | Single center, mixed ICU | All patients | 4 % CHG body wash daily for 5 days | Post-intervention education session for new HCWs, monthly infection control meetings, strict isolation, and cohorting | Acquisition of MRSA colonization and infection | – |
CHG shampoo on day 1 and 5 |
BSI bloodstream infection, CHA chlorhexidine acetate, CHG chlorhexidine gluconate, CLABSI catheter-related bloodstream infections, ICU intensive care unit, ITS interrupted time series, MRSA methicillin-resistant Staphylococcus aureus, RCT randomized controlled trial, S. aureus Staphylococcus aureus, SDD selective digestive decontamination, UTI urinary tract infection, VAP ventilator-associated pneumonia, VRE vancomycin-resistant Enterococci
aThe domain for the CHG intervention is stated. The domain for co-interventions can differ
bOnly taking into account the “neither” and the “CHG” regimen patients
cCalculated from mean monthly admission rate of 138 during 12 months at baseline and 116 during 12 months at intervention phase