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The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis

BACKGROUND: Chlorhexidine gluconate (CHG) bathing of hospitalized patients may have benefit in reducing hospital-acquired bloodstream infections (HABSIs). However, the magnitude of effect, implementation fidelity, and patient-centered outcomes are unclear. In this meta-analysis, we examined the effe...

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Autores principales: Musuuza, Jackson S., Guru, Pramod K., O’Horo, John C., Bongiorno, Connie M., Korobkin, Marc A., Gangnon, Ronald E., Safdar, Nasia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518712/
https://www.ncbi.nlm.nih.gov/pubmed/31088521
http://dx.doi.org/10.1186/s12879-019-4002-7
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author Musuuza, Jackson S.
Guru, Pramod K.
O’Horo, John C.
Bongiorno, Connie M.
Korobkin, Marc A.
Gangnon, Ronald E.
Safdar, Nasia
author_facet Musuuza, Jackson S.
Guru, Pramod K.
O’Horo, John C.
Bongiorno, Connie M.
Korobkin, Marc A.
Gangnon, Ronald E.
Safdar, Nasia
author_sort Musuuza, Jackson S.
collection PubMed
description BACKGROUND: Chlorhexidine gluconate (CHG) bathing of hospitalized patients may have benefit in reducing hospital-acquired bloodstream infections (HABSIs). However, the magnitude of effect, implementation fidelity, and patient-centered outcomes are unclear. In this meta-analysis, we examined the effect of CHG bathing on prevention of HABSIs and assessed fidelity to implementation of this behavioral intervention. METHODS: We undertook a meta-analysis by searching Medline, EMBASE, CINAHL, Scopus, and Cochrane’s CENTRAL registry from database inception through January 4, 2019 without language restrictions. We included randomized controlled trials, cluster randomized trials and quasi-experimental studies that evaluated the effect of CHG bathing versus a non-CHG comparator for prevention of HABSIs in any adult healthcare setting. Studies of pediatric patients, of pre-surgical CHG use, or without a non-CHG comparison arm were excluded. Outcomes of this study were HABSIs, patient-centered outcomes, such as patient comfort during the bath, and implementation fidelity assessed through five elements: adherence, exposure or dose, quality of the delivery, participant responsiveness, and program differentiation. Three authors independently extracted data and assessed study quality; a random-effects model was used. RESULTS: We included 26 studies with 861,546 patient-days and 5259 HABSIs. CHG bathing markedly reduced the risk of HABSIs (IRR = 0.59, 95% confidence interval [CI]: 0.52–0.68). The effect of CHG bathing was consistent within subgroups: randomized (0.67, 95% CI: 0.53–0.85) vs. non-randomized studies (0.54, 95% CI: 0.44–0.65), bundled (0.66, 95% CI: 0.62–0.70) vs. non-bundled interventions (0.51, 95% CI: 0.39–0.68), CHG impregnated wipes (0.63, 95% CI: 0.55–0.73) vs. CHG solution (0.41, 95% CI: 0.26–0.64), and intensive care unit (ICU) (0.58, 95% CI: 0.49–0.68) vs. non-ICU settings (0.56, 95% CI: 0.38–0.83). Only three studies reported all five measures of fidelity, and ten studies did not report any patient-centered outcomes. CONCLUSIONS: Patient bathing with CHG significantly reduced the incidence of HABSIs in both ICU and non-ICU settings. Many studies did not report fidelity to the intervention or patient-centered outcomes. For sustainability and replicability essential for effective implementation, fidelity assessment that goes beyond whether a patient received an intervention or not should be standard practice particularly for complex behavioral interventions such as CHG bathing. TRIAL REGISTRATION: Study registration with PROSPERO CRD42015032523. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12879-019-4002-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-65187122019-05-21 The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis Musuuza, Jackson S. Guru, Pramod K. O’Horo, John C. Bongiorno, Connie M. Korobkin, Marc A. Gangnon, Ronald E. Safdar, Nasia BMC Infect Dis Research Article BACKGROUND: Chlorhexidine gluconate (CHG) bathing of hospitalized patients may have benefit in reducing hospital-acquired bloodstream infections (HABSIs). However, the magnitude of effect, implementation fidelity, and patient-centered outcomes are unclear. In this meta-analysis, we examined the effect of CHG bathing on prevention of HABSIs and assessed fidelity to implementation of this behavioral intervention. METHODS: We undertook a meta-analysis by searching Medline, EMBASE, CINAHL, Scopus, and Cochrane’s CENTRAL registry from database inception through January 4, 2019 without language restrictions. We included randomized controlled trials, cluster randomized trials and quasi-experimental studies that evaluated the effect of CHG bathing versus a non-CHG comparator for prevention of HABSIs in any adult healthcare setting. Studies of pediatric patients, of pre-surgical CHG use, or without a non-CHG comparison arm were excluded. Outcomes of this study were HABSIs, patient-centered outcomes, such as patient comfort during the bath, and implementation fidelity assessed through five elements: adherence, exposure or dose, quality of the delivery, participant responsiveness, and program differentiation. Three authors independently extracted data and assessed study quality; a random-effects model was used. RESULTS: We included 26 studies with 861,546 patient-days and 5259 HABSIs. CHG bathing markedly reduced the risk of HABSIs (IRR = 0.59, 95% confidence interval [CI]: 0.52–0.68). The effect of CHG bathing was consistent within subgroups: randomized (0.67, 95% CI: 0.53–0.85) vs. non-randomized studies (0.54, 95% CI: 0.44–0.65), bundled (0.66, 95% CI: 0.62–0.70) vs. non-bundled interventions (0.51, 95% CI: 0.39–0.68), CHG impregnated wipes (0.63, 95% CI: 0.55–0.73) vs. CHG solution (0.41, 95% CI: 0.26–0.64), and intensive care unit (ICU) (0.58, 95% CI: 0.49–0.68) vs. non-ICU settings (0.56, 95% CI: 0.38–0.83). Only three studies reported all five measures of fidelity, and ten studies did not report any patient-centered outcomes. CONCLUSIONS: Patient bathing with CHG significantly reduced the incidence of HABSIs in both ICU and non-ICU settings. Many studies did not report fidelity to the intervention or patient-centered outcomes. For sustainability and replicability essential for effective implementation, fidelity assessment that goes beyond whether a patient received an intervention or not should be standard practice particularly for complex behavioral interventions such as CHG bathing. TRIAL REGISTRATION: Study registration with PROSPERO CRD42015032523. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12879-019-4002-7) contains supplementary material, which is available to authorized users. BioMed Central 2019-05-14 /pmc/articles/PMC6518712/ /pubmed/31088521 http://dx.doi.org/10.1186/s12879-019-4002-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Musuuza, Jackson S.
Guru, Pramod K.
O’Horo, John C.
Bongiorno, Connie M.
Korobkin, Marc A.
Gangnon, Ronald E.
Safdar, Nasia
The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis
title The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis
title_full The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis
title_fullStr The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis
title_full_unstemmed The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis
title_short The impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis
title_sort impact of chlorhexidine bathing on hospital-acquired bloodstream infections: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518712/
https://www.ncbi.nlm.nih.gov/pubmed/31088521
http://dx.doi.org/10.1186/s12879-019-4002-7
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