Abstract
Background:
Healthcare-associated infections (HAIs) continue to pose a serious threat to critically ill patients, particularly in intensive care units (ICUs) across low- and middle-income countries. The use of invasive devices such as central venous catheters, endotracheal tubes, and urinary catheters substantially increases the risk of bloodstream infections, pneumonia, and urinary tract infections. Daily bathing with chlorhexidine gluconate (CHG) has been suggested as a preventive measure to decrease microbial burden; however, data from South Asian healthcare settings remain scarce. This study examined the impact of routine CHG bathing on infection rates among ICU patients in a tertiary care hospital in Lahore, Pakistan.
Objective:
To determine whether daily bathing with chlorhexidine reduces the incidence of healthcare-associated infections, including bloodstream infections and ventilator-associated pneumonia, among adult ICU patients.
Study Type: Randomized Controlled Trial (RCT)
Methods:
A 12-month, single-center randomized controlled trial was carried out in a 20-bed mixed medical-surgical ICU. Four hundred adult patients anticipated to require ICU care for more than 48 hours were randomly allocated to either daily bathing with 2% CHG (n = 200) or conventional bathing practices (n = 200). The primary endpoint was the occurrence of HAIs—specifically central line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infections (CAUTI)—as defined by CDC guidelines. Secondary outcomes included ICU mortality, duration of ICU stay, colonization with multidrug-resistant organisms (MDROs), and any skin-related adverse effects. Statistical comparisons were conducted using chi-square and independent t-tests, with statistical significance set at p < 0.05.
Results:
Patients who received CHG bathing experienced a significantly lower overall rate of HAIs compared to those in the control group (12% vs. 23%, p = 0.004), corresponding to a relative risk of 0.52 (95% CI: 0.32–0.83). A notable decline was observed in CLABSI incidence (4.5% vs. 9%, p = 0.03). The intervention group also had a shorter average ICU stay (8.2 ± 3.4 days) compared to the standard care group (10.1 ± 4.2 days, p = 0.01). MDRO colonization was less frequent among patients receiving CHG (9% vs. 16%, p = 0.03). Although ICU mortality was lower in the CHG group (14% vs. 17.5%), this difference did not reach statistical significance (p = 0.29). Mild skin irritation occurred in a small proportion of patients (3%), and no severe reactions were documented.
Conclusion:
Routine daily bathing with chlorhexidine was associated with a meaningful reduction in healthcare-associated infections and a shorter ICU stay in critically ill patients. The intervention was well tolerated and contributed to lower MDRO colonization rates. Integrating CHG bathing into standard infection control protocols may enhance patient outcomes in comparable resource-constrained ICU environments.