2% CHG-impregnated cloths vs soap-and-water bathing in reducing HAI in adult patients

Abstract

Individuals admitted to a hospital setting are at risk of acquiring a hospital infection. This may further increase patients’ morbidity and result in a lengthened hospital stay. Studies have shown that 2% chlorhexidine gluconate (CHG) is an effective broad antiseptic. This dissertation analyses literature regarding the effective use of 2% CHG-impregnated cloths and traditional soap-and-water bathing to further reduce hospital acquired infections (HAI) in adult patients. Using the PICO framework, the research question reads ‘Does the use of 2% chlorhexidine gluconate-impregnated cloths for bathing further reduce hospital acquired infections when compared with soap-and-water bathing, in hospitalised adult patients?’ A comprehensive search for relevant studies was carried out in eight databases. The inclusion criteria included studies published in the last 14 years, full-text and English papers, and articles studying specifically the intervention and comparison as outlined in the PICO question. Studies which failed to meet the inclusion criteria were excluded. After applying such criteria, thorough reading and elimination of duplicates, eleven studies were retained including three systematic reviews, two meta-analyses, one randomised controlled trial, two non-randomised controlled trials and three quasi-experimental studies. Such studies were critically appraised according to their study design using the CASP checklist and McMaster tool. Due to a range of HAI analysed within the studies, specific infections were divided into primary and secondary outcomes. The main conclusion was that 2% CHG-impregnated cloths are more beneficial in reducing MRSA and VRE colonisation and infection and primary BSI, while other HAI, such as CAUTI, VAP and Acinetobacter baumanii remain inconclusive, compared to soap-and-water bathing. However, various literature gaps were identified. Recommendations were focused on the need of further research, education to healthcare professionals, a local pilot study to determine the feasibility of a future study performed on a larger scale and, eventually, the implementation of such cloths into the local hospital.