The Effect of Chlorhexidine Gluconate Bathing on Central Line-Associated Bloodstream Infections and Mucosal Barrier Injury-Associated Bloodstream Infections on the Bone Marrow Transplant Unit at Emory University Hospital Open Access

Abstract

Background: Central line-associated bloodstream infections (CLABSI) and mucosal barrier injury-associated bloodstream infections (MBI) are major complications for immunocompromised patients, particularly in bone marrow transplant (BMT) units. CLABSI prevention strategies often involve a bundled approach that includes chlorhexidine gluconate (CHG) bathing, but these strategies should not have an impact on MBI rates. Our study is an attempt to estimate the impact of the specific addition of CHG bathing on CLABSI and MBI rates on the BMT unit at Emory University Hospital.

 

Methods: This retrospective observational cohort study analyzed CLABSI and MBI events using prospectively collected surveillance data from January 2013-June 2022. Infection rates were calculated per 1,000 central line-days and interrupted time series (ITS) analyses using segmented regression models were performed on monthly rate data to evaluate changes before and after the July 2016 implementation of CHG bathing.

 

Results: A total of 346 bloodstream infections (187 MBIs and 159 CLABSIs) were identified. ITS analyses revealed a 44% immediate level decrease in CLABSI rates following CHG bathing implementation, though not statistically significant. The monthly trend in CLABSI rates showed a post-intervention decrease, though it lacked statistical significance. MBI rates also declined post-intervention with a statistically significant downward trend (-1.37% per month, p=0.00015). Infections associated with gram-positive bacteria showed a 34% immediate level decrease post-CHG bathing implementation, and a significant decline in monthly trend (-3.29% per month, p=0.0061). Gram-negative bacteria infections showed a similar trend.

 

Conclusion: CHG bathing was associated with decreased CLABSI and MBI rates, with the greatest impact observed in CLABSI reduction. Continued CHG bathing use is recommended in high-risk units. Future studies should explore compliance, patient education, and implementation across diverse healthcare facilities.

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	healthcare-associated infections interrupted time series analysis quality improvement HAI hospital epidemiology
Committee Chair / Thesis Advisor	Fridkin, Scott, Emory University

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