Two recent studies examined the effects of bathing with chlorhexidine gluconate-impregnated cloths on infection rates in hospitalized patients. The first trial, published by Millstone and colleagues in the Lancet, involved children older than two months in 10 ICUs at five hospitals across the United States. The second study, published by Climo and colleagues in the New England Journal of Medicine (NEJM), involved patients from nine units (ICUs and one bone marrow transplantation unit) at seven U.S. hospitals.

In both studies, units were randomly assigned to perform usual care or the intervention (bathing patients daily with cloths containing 2% chlorhexidine gluconate) for six months; each unit then switched to the opposite treatment for six months.

The Lancet study included 4,072 children, among whom 113 cases of bacteremia occurred: 34 undergoing the intervention and 79 undergoing usual bathing. Overall, children bathed according to standard practices had a 36% higher risk of bacteremia.

The NEJM trial enrolled 7,727 patients and reported similar results: 119 hospital-acquired bloodstream infections with chlorhexidine bathing, compared with 165 with standard bathing (a 28% lower incidence with chlorhexidine). Chlorhexidine bathing resulted in a 23% lower overall risk of infection with multidrug-resistant organisms-a19% lower risk of methicillin-resistant Staphylococcus aureus and a 25% lower risk of vancomycin-resistant enterococcus.

Both studies found lower rates of central-line infection with chlorhexidine bathing: in the pediatric study, 28 cases in the control group, versus 13 in the intervention group; in the NEJM trial, a 53% lower infection rate.

Staphylococci were the most prevalent organisms seen in both studies. The Lancet study found a 46% lower rate of Gram-positive infections in the intervention group than in the control group. Similarly, the incidence of infection with coagulase-negative staphylococci in the NEJM study was 56% lower with chlorhexidine bathing.

The rates of adverse reactions were low in both trials. Neither found an association between unit type and infection rate. The authors of both studies note that the intervention is simple and straightforward to implement and suggest that it could reduce overall health care costs.

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