The effectiveness of chlorhexidine bathing and hospital acquired infections among adult intensive care patients : a trial sequential meta-analysis

Introduction: Hospital acquired infections (HAI) among adults admitted to the intensive care unit (ICU) have been shown to increase length of stay, the cost of care, and rates of hospital deaths. Daily bathing with chlorhexidine gluconate (CHG) has been suggested as a possible solution. However, CHG bathing is not universally practiced. Objectives: This trial sequential meta-analysis aims to explore the current status of evidence for the effectiveness of CHG bathing, among adult intensive care patients, to reduce HAIs, and address the question: do we need more trials? Methods: A systematic literature search was undertaken to identify trials. Particular focusing on: (1) Blood stream infections (BSI); (2) Central Line Associated Blood Stream Infections (CLABSI); (3) Multi-Resistant Drug Organism (MRDO); (4) Ventilator Associated Pneumonia; and, Catheter Associated Urinary Tract Infections (CAUTI). A Trial Sequential Analysis (TSA) was used to describe the current evidence for the effectiveness of CHG bathing. Results: Five trials were included in our final analysis. Daily bathing with CHG was estimated to reduce BSI in the ICU by 29% (Der-Simonian and Laird, Random-Effects (DL-RE) Incidence Rate Ratio (IRR) = 0.71, 95% confidence interval (CI) 0.51, 0.98); reduce CLABSI in the ICU by approximately 40% (DL-RE IRR = 0.60, 95% CI 0.34, 1.04); reduce MDRO in the ICU by approximately 18% (DL-RE IRR = 0.82, 95% CI 0.69, 0.98); no effect in reducing VAP in the ICU (DL-RE IRR = 1.33, 95% CI 0.81, 2.18); and, no effect in reducing CAUTI in the ICU (DL-RE IRR = 0.77, 95% CI 0.52, 1.15). TSA Upper (superiority) monitoring boundaries were not crossed for all five specific infections. Conclusion(s): TSA suggests that more clinical trials are needed to address the current state of ‘clinical equipoise’.