Chlorhexidine baths in PICUs can reduce risk of bloodstream infections

Bathing children in the intensive care units (ICUs) with chlorhexidine solution once daily can reduce the risk of bloodstream infections, according to a study published online in The Lancet.

“The most important finding is that we can cut the risk of bloodstream infections in hospitalized children by using a simple and relatively inexpensive technique-antiseptic bedside baths,” said Aaron Milstone, MD, MHS, assistant professor of pediatrics and epidemiology, and associate hospital epidemiologist, Johns Hopkins Medical Institutions, in Baltimore. “This is the first time we’ve studied this infection-prevention approach in children.

“We found a 36% drop in bloodstream infections among children in intensive care who were bathed with chlorhexidine solution once daily,” he said. “Another important finding is that this technique is safe, and we observed very few and relatively mild side effects.”

Dr. Milstone and colleagues studied a large number of critically ill children-more than 4,000 patients hospitalized in 10 ICUs. They compared infection rates between units where the children were given standard soap and water baths and units where children received antiseptic baths with chlorhexidine.

“Halfway through the trial, we switched the intervention between units to ensure that the effects we were seeing were, in fact, due to the antiseptic baths rather than other random factors,” he said.

According to Dr. Milstone, critically ill children are particularly vulnerable to bloodstream infections because many of them have either compromised immunity or in-dwelling catheters, both of which increase the risk of infection.

“Bloodstream infections can lead to serious complications, including organ damage and, sometimes, death,” he said. “Beyond the human toll, these infections are expensive and can take a serious economic toll on the healthcare system as a whole. As physicians and epidemiologists, we’re always looking for new ways to minimize risk, hence our study.”

These findings are important in terms of infection prevention and patient safety “because they show how a simple clinical intervention can result in serious-and safe-risk reduction,” Dr. Milstone said. “This infection-prevention strategy . . . combines two staples of hospital care-bedside baths and a common antiseptic-into a single powerful intervention. This strategy expands our existing armamentarium for infection prevention and patient safety.”