The Effect of Bathing With Chlorhexidine on MRSA and VRE Colonization in Hematology and Oncology Inpatients

The study was designed as an experimental, 2-arm, cross-over clinical trial, involving patients admitted to ICU of a university oncology hospital between September 2018 and July 2019.

This study was conducted at one medical intensive care unit of an oncology hospital, which is one of the four hospitals of a state university located at the capital city of Turkey. The University is the first public institution in Turkey accredited by the Joint Commission International (JCI) for its quality of health care services. The ICU of the oncology hospital provides care for patients with a variety of medical conditions, but particularly specialized for critical patients with oncological and haematological diseases. The ICU includes eight beds and two isolation rooms each of which has one patient bed, and the average daily admission of patients to ICU was 7.

Using the NCSS-PASS 2007 statistical package program (Blackwelder, 1998), the minimum sample size with 80.0% power and type 1 error of 5.0% was calculated as 58 patients for an inclusion period of 1 year; however 61 patients who met the inclusion criteria composed the study sample.

All patients admitted to the ICU were assessed for eligibility and included to the study sample if they aged over 18 years, diagnosed with a hematologic-oncologic disease and admitted within the first 24 hours to the ICU. Exclusion criteria for participation were; age < 18 years, burns to >20% of the total skin surface, pregnancy, previous MRSA and/or VRE infection history or antibiotic use for these infections, receiving radiation therapy, admitted before 24 hours to ICU, re-admission to ICU, diagnosed with severe septic shock, massive pulmonary thromboembolism, massive haemoptysis, and status epilepticus etc., general condition disorder.

A total of 139 patients with a hematologic-oncologic disease were assessed for eligibility of whom 61 excluded due to discharge (n=11) or death (n=6) before 24 hours of hospitalization, admission to ICU before the eligibility assessment of researcher (n=8), repeated admission to ICU (n=6), severely impaired medical condition (n=6), age under 18 years (n=2), massive pulmonary thromboembolism (n=2), previous MRSA infection (n=2), and severe septic shock (n=1). Seventeen patients did not provide consent for participation and their relatives were not available. After eligibility assessment, 78 patients were randomised into two arms according to the order of admission to the ICU. Arm 1 (39 patients) included first the control period, followed by one-day wash-out, and then the intervention period. Arm 2 (39 patients) included first the intervention period, followed by one-day wash-out, and then the control period. The first patient was assigned to the second arm after the draw, and the patients continued to take the first arm and second arm respectively. Each period lasted three consecutive days with a total of 7 days for each patient. During the period of the study, 8 patients from Arm1 and 9 patients from Arm 2 could not complete the study due to several reasons. Thus, the final sample consisted of 31 patients in Arm 1 and 30 patients in Arm 2.