Raulji, C.M., Clay, K., Velasco, C., & Yu, L.C. (2015). Daily bathing with chlorhexidine and its effects on nosocomial infection rates in pediatric oncology patients. Pediatric Hematology and Oncology, 32, 315–321. 

DOI Link

Study Purpose

To determine the effect of daily bathing with chlorhexidine on nosocomial infection rates

Intervention Characteristics/Basic Study Process

Nosocomial infection rates were compared before and after the implementation of a daily chlorhexidine bathing. A solution of 4% chlorhexidine gluconate was diluted in 10 parts water to 1 part cleanser and was used to rinse all body surfaces except the face.

Sample Characteristics

  • N = 330
  • AGE RANGE = 0–21 years
  • MALES: 54.9%, FEMALES: 45.2%
  • KEY DISEASE CHARACTERISTICS: Multiple tumor types
  • OTHER KEY SAMPLE CHARACTERISTICS: Individuals with fever on admission were excluded from the analysis.

Setting

  • SITE: Single site
  • SETTING TYPE: Inpatient
  • LOCATION: New Orleans

Phase of Care and Clinical Applications

  • PHASE OF CARE: Multiple phases of care
  • APPLICATIONS: Pediatrics

Study Design

  • Retrospective cohort comparison

Measurement Instruments/Methods

  • Infections were recorded based on the presence of a fever for more than 24 hours and/or the presence of positive cultures in bodily fluid.
  • The presence of a fever with no positive cultures was considered presumed infection.
  • The infection rate was quantified as incidence density per 100 days.

Results

The infection rate was lower in the study group compared to historical controls only in those aged 12–21 years (p = 0.008). This age group also showed a higher prevalence of neutropenia (p = 0.039) in the study group. Overall, no significant differences existed in infection rates between study groups.

Conclusions

The results did not show an overall reduction in infections with daily chlorhexidine bathing, although some benefit was seen among older adult patients.

Limitations

  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Differences in the rate of neutropenia between study cohorts existed.

Nursing Implications

The findings did not provide definitive evidence that daily chlorhexidine bathing reduces hospital-acquired infections; however, the rates among older adult patients, who also had a higher prevalence of neutropenia, improved. Chlorhexidine bathing is a simple and potentially low cost intervention that may have some benefit for neutropenic patients. Further research in this intervention is warranted.