Document Detail

Daily chlorhexidine bathing to reduce bacteraemia in critically ill children: a multicentre, cluster-randomised, crossover trial.
MedLine Citation:
PMID:  23363666     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Bacteraemia is an important cause of morbidity and mortality in critically ill children. Our objective was to assess whether daily bathing in chlorhexidine gluconate (CHG) compared with standard bathing practices would reduce bacteraemia in critically ill children.
METHODS: In an unmasked, cluster-randomised, two-period crossover trial, ten paediatric intensive-care units at five hospitals in the USA were randomly assigned a daily bathing routine for admitted patients older than 2 months, either standard bathing practices or using a cloth impregnated with 2% CHG, for a 6-month period. Units switched to the alternative bathing method for a second 6-month period. 6482 admissions were screened for eligibility. The primary outcome was an episode of bacteraemia. We did intention-to-treat (ITT) and per-protocol (PP) analyses. This study is registered with (identifier NCT00549393).
FINDINGS: 1521 admitted patients were excluded because their length of stay was less than 2 days, and 14 refused to participate. 4947 admissions were eligible for analysis. In the ITT population, a non-significant reduction in incidence of bacteraemia was noted with CHG bathing (3·52 per 1000 days, 95% CI 2·64-4·61) compared with standard practices (4·93 per 1000 days, 3·91-6·15; adjusted incidence rate ratio [aIRR] 0·71, 95% CI 0·42-1·20). In the PP population, incidence of bacteraemia was lower in patients receiving CHG bathing (3·28 per 1000 days, 2·27-4·58) compared with standard practices (4·93 per 1000 days, 3·91-6·15; aIRR 0·64, 0·42-0·98). No serious study-related adverse events were recorded, and the incidence of CHG-associated skin reactions was 1·2 per 1000 days (95% CI 0·60-2·02).
INTERPRETATION: Critically ill children receiving daily CHG bathing had a lower incidence of bacteraemia compared with those receiving a standard bathing routine. Furthermore, the treatment was well tolerated.
FUNDING: Sage Products, US National Institutes of Health.
Aaron M Milstone; Alexis Elward; Xiaoyan Song; Danielle M Zerr; Rachel Orscheln; Kathleen Speck; Daniel Obeng; Nicholas G Reich; Susan E Coffin; Trish M Perl;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2013-01-28
Journal Detail:
Title:  Lancet     Volume:  381     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-04-01     Completed Date:  2013-04-08     Revised Date:  2014-08-14    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  1099-106     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Ltd. All rights reserved.
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MeSH Terms
Academic Medical Centers
Administration, Topical
Bacteremia / epidemiology,  prevention & control*
Child, Preschool
Chlorhexidine / administration & dosage,  adverse effects,  analogs & derivatives*
Critical Illness / therapy*
Cross Infection / prevention & control*
Cross-Over Studies
Disinfectants / administration & dosage*,  adverse effects
Drug Eruptions / etiology
Hospitals, University
Intensive Care Units, Pediatric
Investigational New Drug Application
United States
Grant Support
Reg. No./Substance:
0/Disinfectants; MOR84MUD8E/chlorhexidine gluconate; R4KO0DY52L/Chlorhexidine
Ilana Alezra / ; Andrew Lee / ; Claire Beers / ; Judy Ascenzi / ; Ivor Berkowitz / ; Priya Prasad / ; Sarah Smathers / ; Mark Helfaer / ; Larissa Hutchins / ; Pattie Hubbs / ; Mary Pat Darnell / ; Nikoleta Kolovos / ; Paul Checchia / ; Maria Fernandez / ; Dana Jewell / ; Kym Galbraith / ; Amanda Adler / ; Jerry Zimmerman / ; Kelly Merrill / ; Nalini Singh / ; John Berger / ; Donna Donovan / ; Dory Walczak /
Comment In:
Lancet. 2013 Mar 30;381(9872):1078-9   [PMID:  23363665 ]

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