The impact of CHG bathing on healthcare-associated bloodstream infections across a health system serving a predominantly rural population

OBJECTIVE: To evaluate the impact of daily chlorhexidine gluconate (CHG) bathing on healthcare-associated infections (HAIs) in patients in a large health system serving a predominantly rural population. DESIGN: Multi-center, quasi-experimental, before-after study. SETTING: 21 hospitals (including academic, community, and critical access) in a decentralized Appalachian healthcare system. PATIENTS AND INTERVENTIONS: During August and September of 2023, we implemented daily CHG bathing for all patients (of at least two months of age) who had central lines and/or were admitted to an intensive care unit (ICU). METHODS: bloodstream infection (MRSA-BSI), in the 18 months before and after the intervention, excluding a 2-month rollout period. We modeled the standardized infection ratio (SIR) using negative binomial generalized linear mixed effects models, incorporating each hospital's risk-adjusted predicted number of infections (from NHSN). RESULTS: After implementation of daily CHG bathing, we observed significant reductions in bloodstream infections, with a 35% reduction in CLABSIs (incidence rate ratio [IRR] 0.650; 95% CI: 0.502-0.841) and a 40% reduction in MRSA bacteremia (IRR 0.599; 95% CI 0.408-0.880). CONCLUSIONS: Implementation of daily CHG bathing for high-risk patients across a decentralized, Appalachian healthcare system was associated with reductions in CLABSI as well as MRSA bacteremia.