Michael W. Climo, M.D., Deborah S. Yokoe, M.D., M.P.H., David K. Warren, M.D., Trish M. Perl, M.D., Maureen Bolon, M.D., Loreen A. Herwaldt, M.D., Robert A. Weinstein, M.D., Kent A. Sepkowitz, M.D., John A. Jernigan, M.D., Kakotan Sanogo, M.S., and Edward S. Wong, M.D. N Engl J Med 2013;368: R2 Jae Hun Park / Pf. Mi Sook Lee

 Multidrug-resistant organisms (MDROs)  MRSA, VRE  risk of hospital-acquired bloodstream infections a/w the use of central venous catheters  Chlorhexidine gluconate  antiseptic agent that has broad-spectrum activity  antibacterial activity

 Daily bathing with chlorhexidine- impregnated cloths..  Decreasing VRE colonies on skin, VRE contamination of health care workers’ hands by 40%  Reduced the rate of acquisition of VRE among patients by 66% (Vernon et al.)  Reducing primary bloodstream infections by 60% (Bleasdale et al.)

 Patients hospitalized in 6 ICUs, BMT units between Aug ~ Feb  Control : nonantimicrobial washcloths  Intervention : washcloths impregnated with 2% chlorhexidine Gluconate  rinse all body surfaces except the face  Initial 6-month  alternate product during the second 6-month  Group 1(5 units) / 2(4 units)

 Surveillance testing for MRSA, VRE  swabs from the nares (for MRSA)  perirectal area (for VRE)  up to 48 hours after admission and on discharge from the unit

 Hospital-acquired bloodstream infection  detected more than 48 hours after admission to the unit  Primary bloodstream infections  without an attributable secondary source of infection  Central-catheter–associated bloodstream infections  at least one central venous catheter in place within 48 hours before detection of the infection

 Recall of the 2% chlorhexidine– impregnated washcloths(June 28, 2008  Burkholderia cepacia contamination

9/12 n=7727

↓ 23% ↓ 25% ↓ 19% ↓ 28% ↓ 31% ↓ 54%

221 30% 23% 20% 13% ↓ 56% ↓ 53%

 skin reactions to..  2.0% of the chlorhexidine bathing  3.4% of the control product bathing

 Daily bathing with chlorhexidine- impregnated washcloths significantly reduced  the risks of acquisition of MDROs  development of hospital-acquired bloodstream infections