Kamis, 26 Agustus 2010

Daily chlorhexidine in SICU for CLABSI prevention? Not so much.

A nice report is out in Intensive Care Medicine by Kyle Popovich and collegues from Rush University Medical Center in Chicago. In the RUMC SICU the clinicians decided to start using 2% CHG-impregnated clothes in Fall 2005.  The investigators analyzed CLABSI rates using the time-series data in the before period (Sept 2004-October 2005) and after period (November 2005 - October 2006). 

They found no significant difference in the CLABSI rate after the introduction of CHG clothes (3.81/ 1,000 central line days vs. 4.6/1,000 central line days; p = 0.57). A couple things to note.  The first is that they did a great job identifying their study as a quasi-experimental study and using Poisson regression and segmented regression analyses. They reported the Poisson-regression results after segmented regression did not identify changes in slope or intercept around the time of the CHG cloth introduction.  Nice job!  They also used C. diff, BSI, VAP and UTI rates as "control" variables, as they are thought not to be reduced with CHG bathing.  These 'control' variables are called 'non-equivalent dependent variables' and inclusion of these types of "outcomes" improves the internal validity of quasi-experimental studies since they typically would be reduced by other infection prevention interventions but not the intervention under study. Thus, they help rule out the impact of concurrent interventions that could have biased the study findings.

Previous studies, which were also mostly quasi-experimental studies but in MICUs, have found reduced CLABSIs with CHG.  It's great that the authors spent the time writing up and publishing these results and the journal should also be commended.  There's nothing worse than publication bias; negative studies are just as important as positive ones, even if they make decision making more difficult.  The authors concluded that they would not recommend routine use of CHG baths in SICUs; I would recommend further study.

Popovich, et al. Intensive Care Medicine

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