Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trial
Abstract Backgrounds Antiseptic bathing did not reduce central-line (CL) associated bloodstream infection (CLABSI) rates in intensive care units (ICU) according to a recent cluster randomised controlled trial (cRCT). However, this analysis did not consider baseline infection rates. Our post-hoc anal...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-06-01
|
| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13756-023-01260-w |
| _version_ | 1797811269707759616 |
|---|---|
| author | Luisa A. Denkel Frank Schwab Jörg Clausmeyer Michael Behnke Jennifer Golembus Solvy Wolke Petra Gastmeier Christine Geffers the CLIP-ID study group |
| author_facet | Luisa A. Denkel Frank Schwab Jörg Clausmeyer Michael Behnke Jennifer Golembus Solvy Wolke Petra Gastmeier Christine Geffers the CLIP-ID study group |
| author_sort | Luisa A. Denkel |
| collection | DOAJ |
| description | Abstract Backgrounds Antiseptic bathing did not reduce central-line (CL) associated bloodstream infection (CLABSI) rates in intensive care units (ICU) according to a recent cluster randomised controlled trial (cRCT). However, this analysis did not consider baseline infection rates. Our post-hoc analysis of this cRCT aimed to use a before-after comparison to examine the effect of daily bathing with chlorhexidine, octenidine or water and soap (control) on ICU-attributable CLABSI rates. Methods A post-hoc analysis of a multi-center cRCT was done. ICUs that did not yet perform routine antiseptic bathing were randomly assigned to one of three study groups applying daily bathing with 2% chlorhexidine-impregnated cloths, 0.08% octenidine wash mitts or water and soap (control) for 12 months. Baseline data was assessed 12 months before the intervention started when all ICUs routinely used water and soap. Poisson regression and generalised estimating equation models were applied to identify changes of CLABSI rates per 1000 CL days between intervention and baseline periods in each study group. Results The cRCT was conducted in 72 ICUs (24 per study group) including 76,139 patients in the baseline and 76,815 patients in the intervention period. In the chlorhexidine group, incidence density of CLABSI was reduced from 1.48 to 0.90 CLABSI per 1000 CL days comparing baseline versus intervention period (P = 0.0085). No reduction was observed in the octenidine group (1.26 versus 1.47 CLABSI per 1000 CL days, P = 0.8735) and the control group (1.20 versus 1.17, P = 0.3298). Adjusted incidence rate ratios (intervention versus baseline) were 0.63 (95%CI 0.46–0.87, P = 0.0172) in the chlorhexidine, 1.17 (95% CI 0.79–1.72, P = 0.5111) in the octenidine and 0.98 (95% CI 0.60–1.58, P = 0.9190) in the control group. Chlorhexidine bathing reduced CLABSI with gram-positive bacteria, mainly coagulase-negative staphylococci (CoNS). Conclusions In this post-hoc analysis of a cRCT, the application of 2% chlorhexidine-impregnated cloths reduced ICU-attributable CLABSI. This preventive effect of chlorhexidine was restricted to CLABSI caused by gram-positive pathogens (CoNS). In contrast, 0.08% octenidine wash mitts did not reduce CLABSI rates in ICUs. Trial registration Registration number DRKS00010475, registration date August 18, 2016. |
| first_indexed | 2024-03-13T07:21:12Z |
| format | Article |
| id | doaj.art-668bc3c035764122814959d9d71abf4e |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-03-13T07:21:12Z |
| publishDate | 2023-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-668bc3c035764122814959d9d71abf4e2023-06-04T11:38:46ZengBMCAntimicrobial Resistance and Infection Control2047-29942023-06-0112111410.1186/s13756-023-01260-wCentral-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trialLuisa A. Denkel0Frank Schwab1Jörg Clausmeyer2Michael Behnke3Jennifer Golembus4Solvy Wolke5Petra Gastmeier6Christine Geffers7the CLIP-ID study groupInstitute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthInstitute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthInstitute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthInstitute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthInstitute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthInstitute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthInstitute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthInstitute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of HealthAbstract Backgrounds Antiseptic bathing did not reduce central-line (CL) associated bloodstream infection (CLABSI) rates in intensive care units (ICU) according to a recent cluster randomised controlled trial (cRCT). However, this analysis did not consider baseline infection rates. Our post-hoc analysis of this cRCT aimed to use a before-after comparison to examine the effect of daily bathing with chlorhexidine, octenidine or water and soap (control) on ICU-attributable CLABSI rates. Methods A post-hoc analysis of a multi-center cRCT was done. ICUs that did not yet perform routine antiseptic bathing were randomly assigned to one of three study groups applying daily bathing with 2% chlorhexidine-impregnated cloths, 0.08% octenidine wash mitts or water and soap (control) for 12 months. Baseline data was assessed 12 months before the intervention started when all ICUs routinely used water and soap. Poisson regression and generalised estimating equation models were applied to identify changes of CLABSI rates per 1000 CL days between intervention and baseline periods in each study group. Results The cRCT was conducted in 72 ICUs (24 per study group) including 76,139 patients in the baseline and 76,815 patients in the intervention period. In the chlorhexidine group, incidence density of CLABSI was reduced from 1.48 to 0.90 CLABSI per 1000 CL days comparing baseline versus intervention period (P = 0.0085). No reduction was observed in the octenidine group (1.26 versus 1.47 CLABSI per 1000 CL days, P = 0.8735) and the control group (1.20 versus 1.17, P = 0.3298). Adjusted incidence rate ratios (intervention versus baseline) were 0.63 (95%CI 0.46–0.87, P = 0.0172) in the chlorhexidine, 1.17 (95% CI 0.79–1.72, P = 0.5111) in the octenidine and 0.98 (95% CI 0.60–1.58, P = 0.9190) in the control group. Chlorhexidine bathing reduced CLABSI with gram-positive bacteria, mainly coagulase-negative staphylococci (CoNS). Conclusions In this post-hoc analysis of a cRCT, the application of 2% chlorhexidine-impregnated cloths reduced ICU-attributable CLABSI. This preventive effect of chlorhexidine was restricted to CLABSI caused by gram-positive pathogens (CoNS). In contrast, 0.08% octenidine wash mitts did not reduce CLABSI rates in ICUs. Trial registration Registration number DRKS00010475, registration date August 18, 2016.https://doi.org/10.1186/s13756-023-01260-wCLABSIAntiseptic bathingChlorhexidine gluconateOctenidine dihydrochloridePost-hoc before-after analysis |
| spellingShingle | Luisa A. Denkel Frank Schwab Jörg Clausmeyer Michael Behnke Jennifer Golembus Solvy Wolke Petra Gastmeier Christine Geffers the CLIP-ID study group Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trial Antimicrobial Resistance and Infection Control CLABSI Antiseptic bathing Chlorhexidine gluconate Octenidine dihydrochloride Post-hoc before-after analysis |
| title | Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trial |
| title_full | Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trial |
| title_fullStr | Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trial |
| title_full_unstemmed | Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trial |
| title_short | Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine: a post-hoc analysis of a cluster-randomised controlled trial |
| title_sort | central line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine a post hoc analysis of a cluster randomised controlled trial |
| topic | CLABSI Antiseptic bathing Chlorhexidine gluconate Octenidine dihydrochloride Post-hoc before-after analysis |
| url | https://doi.org/10.1186/s13756-023-01260-w |
| work_keys_str_mv | AT luisaadenkel centrallineassociatedbloodstreaminfectionsinintensivecareunitsbeforeandafterimplementationofdailyantisepticbathingwithchlorhexidineoroctenidineaposthocanalysisofaclusterrandomisedcontrolledtrial AT frankschwab centrallineassociatedbloodstreaminfectionsinintensivecareunitsbeforeandafterimplementationofdailyantisepticbathingwithchlorhexidineoroctenidineaposthocanalysisofaclusterrandomisedcontrolledtrial AT jorgclausmeyer centrallineassociatedbloodstreaminfectionsinintensivecareunitsbeforeandafterimplementationofdailyantisepticbathingwithchlorhexidineoroctenidineaposthocanalysisofaclusterrandomisedcontrolledtrial AT michaelbehnke centrallineassociatedbloodstreaminfectionsinintensivecareunitsbeforeandafterimplementationofdailyantisepticbathingwithchlorhexidineoroctenidineaposthocanalysisofaclusterrandomisedcontrolledtrial AT jennifergolembus centrallineassociatedbloodstreaminfectionsinintensivecareunitsbeforeandafterimplementationofdailyantisepticbathingwithchlorhexidineoroctenidineaposthocanalysisofaclusterrandomisedcontrolledtrial AT solvywolke centrallineassociatedbloodstreaminfectionsinintensivecareunitsbeforeandafterimplementationofdailyantisepticbathingwithchlorhexidineoroctenidineaposthocanalysisofaclusterrandomisedcontrolledtrial AT petragastmeier centrallineassociatedbloodstreaminfectionsinintensivecareunitsbeforeandafterimplementationofdailyantisepticbathingwithchlorhexidineoroctenidineaposthocanalysisofaclusterrandomisedcontrolledtrial AT christinegeffers centrallineassociatedbloodstreaminfectionsinintensivecareunitsbeforeandafterimplementationofdailyantisepticbathingwithchlorhexidineoroctenidineaposthocanalysisofaclusterrandomisedcontrolledtrial AT theclipidstudygroup centrallineassociatedbloodstreaminfectionsinintensivecareunitsbeforeandafterimplementationofdailyantisepticbathingwithchlorhexidineoroctenidineaposthocanalysisofaclusterrandomisedcontrolledtrial |