Would you like some chlorhexidine with that?

More evidence is out this month regarding the benefits of chlorhexidine in infection prevention.  This multicenter, randomized trial, published in JAMA, demonstrated that chlorhexidine-gluconate impregnated sponge dressings could significantly reduce the rate of catheter-related bloodstream infections.  This comes as other evidence accumulates that chlorhexidine bathing of ICU patients also might reduce the rate of bloodstream infection (so-called "source control"). 

 

A couple things are notable about this new JAMA study, however:

First, a significant reduction in BSI was found despite the fact that the ICUs involved already had very low infection rates (less than 2 per 1K cath days). Conventional wisdom has it that hospitals should first implement the standard "bundle" for BSI prevention, which includes a checklist to ensure good practice for line insertion and care.  Only those hospitals with continued high rates (defined by many as more than 2 or 3 infections per 1K cath days) should then consider the addition of more "technological" approaches (such as chlorhexidine dressings or antimicrobial impregnated catheters).  This study strongly supports the addition of chlorhexidine dressings to the prevention bundle, from the beginning.

Second, and more importantly, this is a great example of the kind of study we should be doing in infection prevention!  Much of current practice is based upon poorly designed, single center, "before-after" studies, due in large part to a lack of funding for well-designed randomized controlled trials (which are both difficult and expensive!).  This study was funded not by industry (though Ethicon did provide the dressings for free), but by the French Ministry of Health; it now represents an important addition to our knowledge, and has helped to answer a question that the most recent CDC guidelines rightly concluded was an "unresolved issue".  Bravo!

The accompanying editorial, by Eli Perencevich and Didier Pittet, is also well worth reading.