Chlorhexidine Bathing to Prevent Central-line-associated Bloodstream Infections in Hematology Units: a Prospective Controlled Cohort Study

BACKGROUND: Patients with hematological malignancies hospitalized for myelosuppressive chemotherapy are at high risk of life-threatening healthcare-associated infections, despite the use of oral prophylactic antibiotics. Chlorhexidine (CHG) bathing decreases incidence of bloodstream infections at intensive care units, but its effect has been understudied in patients with hematological malignancies at non-critical-care units. METHODS: Adults with hematological malignancies hospitalized for cytotoxic chemotherapy at non-critical-care units were offered daily 2% CHG bathing. We compared outcomes of patients chose to take CHG bathing (CHG group) and that of those chose not to take (usual care group). The primary outcome was gram-positive cocci, skin-flora-related, or central-line-associated bloodstream infection. The negative-control outcome was gut-origin bacteremia. Outcomes were monitored by a rule-based healthcare associated infections surveillance and classification system. RESULTS: The CHG group (n=485) had a crude incidence rate of primary outcome 60% lower than that in the usual care group (n=408) (3.4 vs. 8.4 per 1,000 patient-days, P=0.02) but had a similar crude incidence rate of negative-control outcome (4.5 vs. 3.2 per 1,000 patient-days, P=0.10). In multivariable analyses, CHG bathing was associated with a 60% decrease in the primary outcome (adjusted hazard ratio [HR] 0.4, P<0.001). In contrast, CHG bathing had no effect on the negative-control outcome (adjusted HR=1.1, P=0.781). CHG bathing was well tolerated by participants in the CHG group. CONCLUSIONS: CHG bathing could be a highly effective approach to prevent gram-positive-cocci-, skin-flora-related, or central-line-associated bacteremia in patients with hematological malignancies who are hospitalized for cytotoxic chemotherapy at non-critical-care units.