Patients in intensive care units who are bathed daily with antiseptic wipes instead of ordinary soap and water have significantly lower rates of bloodstream infections and are less likely to acquire antibiotic-resistant bacteria on the skin, a new study shows.
The findings point to a relatively simple way to prevent infections among some of the sickest patients in the hospital. Patients in the ICU have a high risk of infections because potentially harmful bacteria on the skin can enter tubes that deliver medicine into the body or that help patients breathe.
Researchers at Washington University School of Medicine in St. Louis and other institutions evaluated the use of antiseptic wipes on nearly 7,000 patients in intensive care or bone marrow transplantation units in six hospitals, including Barnes-Jewish Hospital.
Their findings were published Feb. 7 in the New England Journal of Medicine.
“It’s been standard practice to bathe ICU patients daily,” says David Warren, MD, medical director for infection prevention at the School of Medicine and Barnes-Jewish. “Switching from soap and water to wipes soaked in the antiseptic chlorhexidine is easy to do and is cost effective, especially given the significant health benefit to patients.”
For the study, ICUs or bone marrow transplant units were randomly selected to wash all patients with the chlorhexidine wipes or soap and water for six months. Each unit then switched to the other method of bathing patients for the next six months.
Patients were monitored for bloodstream infections and the presence of two types of antibiotic-resistant bacteria on the skin, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). Both are concerning because they cause infections that often can’t be easily treated with standard antibiotics.
Among patients treated with soap and water, there were 165 new cases of antibiotic-resistant bacteria on the skin, compared to 127 cases for patients washed with chlorhexidine – a 23 percent reduction.
Bathing with the chlorhexidine wipes also significantly reduced the rate of bloodstream infections by 28 percent, a benefit that was most pronounced among patients who stayed in the ICU for more than seven days.
Chlorhexidine is effective against a broad range of organisms and has a residual effect even after bathing, keeping bacteria at bay. This also helps to reduce the transmission of bacteria from patient to patient.
Based on the study’s preliminary results and other related research, nurses at Barnes-Jewish Hospital began bathing ICU patients with chlorhexidine in 2007. Rather than using the wipes, the hospital uses a chlorhexidine body wash, which is just as effective, Warren says.
The research is supported by the Centers for Disease Control and Prevention (5UO1C1000395-02) and Sage Products, the maker of the chlorhexidine wipes.
Climo MW, Yokoe DS, Warren DK, Perl TM, Bolon M, Herwaldt LA, Weinstein RA, Sepkowitz KA, Jernigan JA, Sanogo K, Wong ES. Effect of daily chlorhexidine bathing on hospital-acquired infection. New England Journal of Medicine
. Feb. 7, 2013.
Washington University School of Medicine’s 2,100 employed and volunteer faculty physicians also are the medical staff of Barnes-Jewish and St. Louis Children’s hospitals. The School of Medicine is one of the leading medical research, teaching and patient care institutions in the nation, currently ranked sixth in the nation by U.S. News & World Report. Through its affiliations with Barnes-Jewish and St. Louis Children’s hospitals, the School of Medicine is linked to BJC HealthCare.