Chlorhexidine wipes don’t prevent ICU infections

The current study suggests that widespread adoption of daily chlorhexidine bathing is not indicated at this time. Rather, institutions with infection rates similar to those reported should adopt a simpler, less expensive approach that focuses on basic hygiene practices, according to Dr. Didier Pittet and Dr. Derek Angus.

Although chlorhexidine bathing was found previously to reduce health care–acquired infection, the largest benefit appears to be in settings with a high baseline prevalence of multidrug-resistant organisms. In these settings, the same potential benefits could be gained through other approaches, such as improved hand hygiene, which may be safer and less likely to affect the ecology of bacterial resistance in the ICU.

Widespread treatment of patients with antimicrobials – whether antibiotics, antivirals, antifungals, or biocides – has never been a good idea. Issues around chlorhexidine use include allergy, costs, resistance, and even safety. Widespread use of biocidal antiseptics might constitute a biologic hazard via increased selective pressure on microbial populations, potentially allowing more pathogenic organisms to flourish or facilitating resistance gene transfer.

These remarks were excerpted from an accompanying editorial (JAMA 2015 Jan. 20 [doi:10.1001/jama.2014.18482]).

Dr. Pittet is director of the infection control program at the University of Geneva Hospitals in Switzerland. Dr. Angus is chair of the department of critical care medicine at the University of Pittsburgh Medical Center. They reported having no financial disclosures.