Chlorhexidine gluconate significantly reduces CLABSI
Abstract:
Background and aims: Central line-associated bloodstream infections (CLABSI) represent a major clinical concern due to their impact on morbidity, mortality, and healthcare costs. This meta-analysis aimed to evaluate the effectiveness of chlorhexidine gluconate (CHG) in preventing CLABSI.
Methods: We systematically searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) database, supplemented by manual complementary searches, with the search period covering from inception to September 2026. Statistical analyses were performed using Review Manager 5.3 and Stata 18.0 software. For dichotomous outcomes, relative risk (RR) with its 95% confidence interval (CI) was used as the effect measure, and the choice between fixed-effect and random-effects models was determined based on the I2 statistic for heterogeneity. Quality assessment and robustness testing were conducted through risk of bias (RoB) evaluation, funnel plots, and leave-one-out sensitivity analyses. All analyses were considered statistically significant at a two-sided P value < 0.05.
Results: A total of 15 studies were ultimately included, comprising 139,251 subjects, with 64,979 in the observation group (OG; CHG intervention) and 74,272 in the control group (CG). The OG group accumulated 324,983 catheter-days with 273 CLABSI cases, while the CG accumulated 243,413 catheter-days with 436 cases. Pooled analysis showed that CHG significantly reduced the risk of CLABSI (RR=0.57, 95% CI: 0.38-0.86, P=0.008). Subgroup analysis showed that catheter coating/impregnation (RR=0.207, P<0.001) and dressing (RR=0.566, P=0.044) interventions were effective, whereas daily bathing was not (RR=0.998); intervention type explained part of the heterogeneity (P<0.001 between subgroups). Sensitivity analysis confirmed that the conclusions were robust; the Egger's test suggested possible publication bias (P=0.041).
Conclusion: CHG intervention can significantly reduce the risk of CLABSI, and the protective effect varies by intervention type: catheter coating/impregnation interventions have the strongest protective effect, dressing interventions have a moderate protective effect, while daily bathing showed no significant effect. Although there was high heterogeneity among studies and possible publication bias, sensitivity analysis confirmed that the pooled conclusions were robust. In clinical practice, CHG-coated/impregnated catheters and CHG dressings can be prioritized as CLABSI prevention strategies, while more high-quality, large-sample randomized controlled trials (RCTs) are still needed to further verify the effect of bathing interventions and correct for potential publication bias.
Reference:
Zhang Q, Tang J, Dong W, Deng Q, Xiao G. Chlorhexidine Gluconate Significantly Reduces Central Line-Associated Bloodstream Infections:A Systematic Review and Meta-Analysis. J Hosp Infect. 2026 Nov 12:S0195-6701(26)00435-4. doi: 10.1016/j.jhin.2026.11.002. Epub ahead of print. PMID: 43020276.