Abstract:
Objectives: Our study aimed to compare the effect of daily bathing with chlorhexidine, octenidine or water and soap (routine care = control) on central-line (CL) associated bloodstream infection (CLABSI) rates in intensive care units (ICUs).
Methods: A multi-center cluster-randomised controlled trial was done with a 12-months intervention period from February 1, 2017, to January 31, 2018 (octenidine and routine care group) or from June 1, 2017 to May 31, 2018 (chlorhexidine group). Wards were randomly assigned to one of two decolonisation regimes or routine care (control). Intervention included daily bathing with 2% chlorhexidine-impregnated cloths or 0.08% octenidine wash mitts for 12 months, while the control group used water and soap (routine care). The primary outcome was incidence density of CLABSI per 1,000 CL days. Poisson regression and generalised estimating equation models (GEE) were applied.
Results: A total of 72 ICUs with 76,815 patients (22,897 patients in the chlorhexidine group, 25,127 in the octenidine group and 28,791 in the routine care group) were included. Incidence densities were 0.9 CLABSI per 1,000 CL days (95%CI 0.67 – 1.19) in the chlorhexidine group, 1.47 (95%CI 1.17 – 1.81) in the octenidine group and 1.17 (95%CI 0.93 – 1.45) in the routine care group. Adjusted incidence rate ratios of CLABSI were 0.69 (95%CI 0.37-1.22, p=0.25) in the chlorhexidine and 1.22 (95%CI 0.54-2.75, p=0.63) in the octenidine group (compared with routine care).
Conclusion: Antiseptic bathing with 2% chlorhexidine-impregnated cloths and 0.08% octenidine wash mitts lack a significant preventive effect on CLABSI rates in ICUs. However, our trial has a high likelihood of being underpowered as CLABSI rates in the routine care group were approximately 40% lower than initially assumed. This trial is registered with the German register for clinical trials (18/08/2016, number DRKS00010475).
Reference:Denkel LA, Schwab F, Clausmeyer J, Behnke M, Golembus J, Wolke S, Gastmeier P, Geffers C. Effect of antiseptic bathing with chlorhexidine or octenidine on central-line associated bloodstream infections in intensive care patients: a cluster-randomised controlled trial. Clin Microbiol Infect. 2022 Jan 11:S1198-743X(21)00731-X. doi: 10.1016/j.cmi.2021.12.023. Epub ahead of print. PMID: 35031487.