Central-line associated bloodstream infections in intensive care units before and after implementation of daily antiseptic bathing with chlorhexidine or octenidine - A post-hoc analysis of a cluster-randomised controlled trial

Abstract

Abstract Backgrounds: Antiseptic bathing did not reduce central-line (CL) associated bloodstream infection (CLABSI) rates in intensive care units (ICU) according to a recent cluster randomised controlled trial (cRCT). However, this analysis did not consider baseline infection rates. Our post-hoc analysis of this cRCT aimed to use a before-after comparison to examine the effect of daily bathing with chlorhexidine, octenidine or water and soap (control) on ICU-attributable CLABSI rates. Methods: A post-hoc analysis of a multi-center cRCT was done. ICUs that did not yet perform routine antiseptic bathing were randomly assigned to one of three study groups applying daily bathing with 2% chlorhexidine-impregnated cloths, 0.08% octenidine wash mitts or water and soap (control) for 12 months. Baseline data was assessed 12 months before the intervention started when all ICUs routinely used water and soap. Poisson regression and generalised estimating equation (GEE) models were applied to identify changes of CLABSI rates per 1000 CL days between intervention and baseline periods in each study group. Results: The cRCT was conducted in 72 ICUs (24 per study group) including 76,139 patients in baseline and 76,815 patients in intervention period. In the chlorhexidine group, incidence density of CLABSI was reduced from 1.48 to 0.90 CLABSI per 1000 CL days comparing baseline versus intervention period (p = 0.0085). No reduction was observed in the octenidine group (1.26 versus 1.47 CLABSI per 1000 CL days, p = 0.8735) and the control group (1.20 versus 1.17, p = 0.3298). Adjusted incidence rate ratios (intervention versus baseline) were 0.63 (95%CI 0.46 – 0.87, p=0.0172) in the chlorhexidine, 1.17 (95%CI 0.79 – 1.72, p=0.5111) in the octenidine and 0.98 (95%CI 0.60 – 1.58, p=0.9190) in the control group. The preventive effect of chlorhexidine was particularly found in ICUs with ≥0.8 CLABSI per 1000 CL days at baseline. Conclusions: This post hoc before-after analysis of a cluster-randomised decolonisation trial suggests that especially ICUs with CLABSI rates ≥0.8 but not < 0.8 CLABSI per 1000 CL might benefit from application of 2% chlorhexidine-impregnated cloths. Antiseptic bathing with 0.08% octenidine wash mitts did not reduce ICU-attributable CLABSI. Trial registration: Registration number DRKS00010475, registration date August 18, 2016