Effect of didecyl dimethyl ammonium chloride (DDAC)-impregnated washcloth wipe whole-body bathing (WBB) on catheter-related blood stream infections (CRBSI) and central venous line-associated infections (CLAI) in adult intensive care units (ICUs).

Abstract

OBJECTIVE\nTo investigate the effect of daily whole-body bathing (WBB) using disposable washcloth wipes/caps impregnated with an antiseptic solution containing the quaternary ammonium base compound didecyl dimethyl ammonium chloride (DDAC) METHODS: A prospective double-blind randomized-crossover trial was conducted to compare WBB of adult ICU patients with washcloth wipes/caps impregnated with either regular cleanser/shampoo or the antiseptic DDAC. The clinical trial was performed in a medical ICU (MICU) and a surgical ICU (SICU). The study period was divided into two six-month intervals with alternating treatment regimens.\n\n\nRESULTS\nA total of 1,540 ICU-patients with total ICU length of stay of 10,470\xa0days were included in the trial. Compared to controls, DDAC bathing was found to be associated with reduced incidence rates per 1,000 patient days for central venous line-associated infections (CLAI) caused by gram-positive bacteria (GPB) from 16.39 (95%CI: 13.1-20.3) in the control group to 7.28 (95%CI: 5.2-9.9) in the intervention group (p=.01). A stratified analysis by unit showed that the incidence rates of CLAI due to GPB were reduced by the intervention in both the MICU and the SICU from 21.2 (95%CI: 15.8-27.7) to 9.3 (95%CI: 5.8-14.1) (p<.01) and from 12.1 (95%CI: 8.3-17.0) to 5.7 (95%CI: 3.4-9.1) (p=.01), respectively. There was a trend towards reduction of CRBSI and BSI, however, this did not reach statistical significance due to carry-over effects and small numbers.\n\n\nCONCLUSIONS\nGiven the growing need for new concepts to prevent and control healthcare-associated infections, DDAC may be a new and promising agent for WBB of ICU patients.