Bass, P., Karki, S., Rhodes, D., Gonelli, S., Land, G., Watson, K., . . . Cheng, A. C. (2013). Impact of chlorhexidine-impregnated washcloths on reducing incidence of vancomycin-resistant enterococci colonization in hematology-oncology patients. American Journal of Infection Control, 41, 345–348.

To evaluate the impact of daily use of 2% chlorhexidine washcloths on the incidence of vancomycin-resistant enterococci (VRE) colonization.

The incidence of VRE colonization among oncology inpatients was examined before and after the introduction of daily use of chlorhexidine-impregnated washcloths. Each day, patients were given four impregnated washcloths, which were used individually for cleaning different parts of the body. Rectal swabs were taken on all new admissions and weekly during the inpatient stay. The baseline period was March to June 2010, and the experimental period was July to October 2010. Patients were in single rooms, although patients colonized with resistant organisms were roomed together. Prior bed occupancy with a patient colonized with VRE was used as a covariate in analysis.

• The study examined 439 total patients (229 at baseline and 210 experimental).
• Males comprised 63.5% of the sample, and females comprised 35.5%.
• Key disease characteristics were not stated.
• Preliminary data showed that 12% of patients became colonized with VRE during the hospital stay.

• Single site
• Inpatient
• Australia

Patients were undergoing the active antitumor treatment phase of care. 

This was an observational study with a historical control. 

• VRE isolates
• Methicillin-resistant Staphylococcus aureus (MRSA) isolates

During the baseline period, 7.8% of the previously uncolonized patients acquired VRE, compared to 3.8% during the experimental period (relatve risk [RR] = 0.48; 95% confidence interval [CI] [0.21, 1.09]). There was no significant effect of prior bed occupants with VRE on VRE acquisition. Patients who shared a room with a VRE-positive patient had significantly higher VRE rates (p < 0.001). There were no significant differences in central line-associated bloodstream infection rates, and few MRSA isolates were found.

The findings do not support the effectiveness of using chlorhexidine-imgregnated washcloths for the reduction of VRE colonization.

• Risk of bias (no control group, no blinding, no random assignment)
• No information was available regarding treatments, tumor types, and aspects associated with risk of infection or use of any prophylaxis for infection prevention.  
• At one point, the researchers stated that patients had private rooms unless colonized, and then they reported that sharing a room with a colonized patient increased the risk, which does not make sense.

The findings from this study do not support the effectiveness of using chlorhexidine-impregnated washcloths to prevent VRE colonization.