• Heather L Evans, Timothy H Dellit, Jeannie Chan, Avery B Nathens, Ronald V Maier, and Joseph Cuschieri.
• Department of Surgery, Harborview Medical Center, 325 9th Ave., Seattle, WA 98104, USA. hlevans@u.washington.edu
• Arch Surg. 2010 Mar 1;145(3):240-6.

ObjectiveTo demonstrate whether daily bathing with cloths impregnated with 2% chlorhexidine gluconate will decrease colonization of resistant bacteria and reduce the rates of health care-associated infections in critically injured patients.DesignRetrospective analysis of data collected 6 months before and after institution of a chlorhexidine bathing protocol.SettingA 12-bed intensive care unit in a level I trauma center.PatientsTwo hundred eighty-six severely injured patients underwent daily chlorhexidine bathing during the 6-month intervention; 253 patients were bathed without chlorhexidine prior to the intervention.InterventionsDaily chlorhexidine bathing.Main Outcomes MeasuresRates of ventilator-associated pneumonia (VAP), bloodstream infection, and colonization with resistant organisms (methicillin-resistant Staphylococcus aureus [MRSA] or Acinetobacter species).ResultsBaseline patient and injury characteristics were similar between cohorts. Patients receiving chlorhexidine baths were significantly less likely to acquire a catheter-related bloodstream infection than comparators (2.1 vs 8.4 infections per 1000 catheter-days, P = .01). The incidence of VAP was not affected by chlorhexidine baths (16.9 vs 21.6 infections per 1000 ventilator-days in those with vs those without chlorhexidine baths, respectively, P = .30). However, patients who received chlorhexidine baths were less likely to develop MRSA VAP (1.6 vs 5.7 infections per 1000 ventilator-days, P = .03). The rate of colonization with MRSA (23.3 vs 69.3 per 1000 patient-days, P < .001) and Acinetobacter (1.0 vs 4.6 per 1000 patient-days, P = .36) was significantly lower in the chlorhexidine group than in the comparison group.ConclusionsDaily bathing of trauma patients with cloths impregnated with 2% chlorhexidine gluconate is associated with a decreased rate of colonization by MRSA and Acinetobacter and lower rates of catheter-related bloodstream infection and MRSA VAP.

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