Antimicrobial Trumps Soap and Water in the ICU

Multiple centers from Iowa City to Boston suggest the results can be extrapolated to apply to various regions of the country, both urban and rural.

"This has not been standard of care, and the controversy has been, is the daily chlorhexidine wash evidence-based enough to make it standard of care," says study author Edward S. Wong, MD, chief of infectious diseases at the Hunter Holmes McGuire Veterans Affairs Medical Center in Richmond, VA.

"And then, if it should be standard of care, should it be in the intensive care unit only, with high risk patients, or should it be generalized to the whole acute care population?  I know in our region, most hospitals don't use it at all."

The multi-center, cluster-randomized trial certainly had enough power—7,727 patients—and tested incidence of infections in hospital settings where they are most likely to thrive: nine medical/surgical intensive care units and bone marrow transplant units, including coronary care and surgery. 

Researchers were so judicious that three other centers were kicked out for not following the protocol closely enough.

And the trial was a crossover, which means hospital units whose patients were assigned to be cleaned with chlorhexidine wash cloths were reassigned six months later to be cleaned with the non-antimicrobial wash cloths, and vice versa, to eliminate any factors in a particular setting being blamed for biasing the result.