| Summary: | 碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 105 === Background
Hematology patients undergoing immunocompromising cytotoxic chemotherapy are at risk for healthcare-associated infections. It remains unclear whether daily bathing with 2% chlorhexidine can reduce the risk. The aim of this study is to compare the incidence of healthcare-associated bloodstream infection (HABSI) between patients using of 2% CHG daily bath and those using general antibacterial cleansers daily bath.
Methods
This was a single-arm prospective interventional study. Patients admitted to two hematological units during the period from December 2015 to June 2016 were the study population. We recruited patients to receive 2% CHG daily bath (intervention group). Those who refused to participate were provided with general antibacterial cleansers daily bath (control group). The incidence rate of skin flora-related bloodstream infection (SKIN_BSI), central venous catheter (CVC)-associated bloodstream infection (CLABSI_CVC), and HABSI of the intervention group were compared with that of the control group.
Results
In total, 485 patients were enrolled as the intervention group, and the other 408 patients served as control group. Compared with the control group, the incidence rate of first SKIN_BSI was reduced by 65.5% (1.0 vs 2.9 per 1,000 patient-day, p=0.012), the incidence rate of first CLABSI_CVC was reduced by 61% (6.6 vs 16.9 per 1,000 patient-day, P = 0.005) and the incidence rate of first HABSI was reduced by 35% (7.8 vs 12.0 per 1,000 patient-day, P=0.035) in the intervention group. After adjusting for effects of confounding variables by logistic regression, the 2% CHG daily bath reduces the risk of first SKIN_BSI by 70% (adjusted OR=0.3, P=0.02), the risk of first CLABSI_CVC by 68% (adjusted OR=0.32, P=0.01), and the risk of first HABSI by 59% (adjusted OR=0.41, P=0.002). In contrast, the risk of gut-origin bacteremia, such as Escherichia coli and Klebsiella pneumoniae-related bloodstream infection, did not change (adjusted OR=0.99, P=0.99).
Conclusion
Daily bathing with 2% CHG is effective in reducing skin flora-related bloodstream infection and cathether-related bacteremia. We recommend routine adoption of this simple and low-cost intervention to reduce BSI among patients with hematological malignancy.
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