Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please can you give a brief introduction to bedside bathing? What has it traditionally been used for?
Bedside baths in the hospital are nothing new. They are typically done for patient comfort and to maintain basic personal hygiene.
When did the idea of daily antibacterial baths originate?
The first studies of daily bathing were about 5 years ago in hospitalized adults, when the protective effects of chlorhexidine in adults was observed, so trying this in children was the next logical step.
This is a fairly simple concept. We decided to take two staples of hospital care—bedside baths and a common antibacterial solution—and combine them into a single intervention to see if it could reduce infections in children.
How did your research assess the benefits of daily antibacterial baths?
We conducted the research in 10 pediatric intensive care units. In half of the units, children received traditional soap-and-water baths, while those in the other half received antiseptic baths.
We found that children on the antiseptic bathing regimen had 36 per cent fewer infections, which, in epidemiology, is a very large reduction.
A particular strength of the study was that halfway through, we switched interventions across the units to ensure the effect we observed was, in fact, due to the antiseptic baths rather than some random, unit-specific factors.
What types of infections were reduced by antiseptic bathing?
Our study found a reduction in bloodstream infections. Other studies have seen a reduction in other healthcare associated infections, including those due to antibiotic resistant bacteria.
How much of a problem are bloodstream infections in children?
They are a serious threat in critically ill children, who are particularly vulnerable because of long-term catheter use or simply due to compromised immune status.
We also know these infections can cause serious damage, including organ failure and even death.
The financial toll on the healthcare system as a whole is high because each infection episode adds about $39,000 in treatment.
Do you think the use of antibacterial baths is economically advantageous?
Our primary goal is to prevent infections. Because antiseptic baths can prevent more than just one outcome (for example, may reduce the risk of a bloodstream infection and reduce the risk of a patient getting an infection with MRSA), determining the exact cost savings is complicated.
More work is needed to determine what are the most cost-effective strategies to reduce infections in hospitalized patients.
How does the risk of bloodstream infections in children compare to the risk in adults?
It really depends on the population. Some children are at higher or similar rates and some have a lower risk. Bloodstream infections remain the most common infection that children develop in the hospital.
Did any of the children experience side effects to the antibacterial baths?
Yes, there were some side effects, but they were few and mild. Most side effects were related to skin sensitivity. We feel chlorhexidine baths are quite safe, overall in this population.
Are there other antibacterial solutions that can be used for patients with sensitivity to chlorhexidine?
Yes, there are other antiseptic solutions that may work, but they have not been studied to this extent. This is another important area to explore.
What impact do you think this research will have?
At Johns Hopkins Children’s Center, we have already made antiseptic baths the standard of care for critically ill children greater than two months of age. We are hoping that other hospitals will do the same.
We believe our findings can potentially redefine how we, as clinicians, view bedside baths—from a purely comfort measure to a clinical intervention to prevent infection.
Why have antiseptic baths not been made the standard of care for children under 2 months of age?
Children under 2 months of age can have sensitive skin. Premature infants may be at increased risk of these chemicals being absorbed through the skin into the blood.
People have been using antiseptics on the skin of young children for decades, so there is a lot of experience, but some concerns remain. So, we are in the process of studying the safety and tolerability of antiseptics applied to the skin of younger children.
Are there any plans for further research into the benefits of antiseptic baths?
We are currently studying the effects of daily antiseptic baths on antibiotic-resistant bacteria, including MRSA. We also need to measure the impact of antiseptic baths on children outside of the intensive care unit and on children less than 2 months of age.
Where can readers find more information?
Johns Hopkins Children’s Center: www.hopkinschildrens.org
The Lancet: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61687-0/fulltext
About Aaron Milstone
Dr. Milstone graduated from Yale University School of Medicine in 2000, and trained in paediatrics at Children’s Hospital of Philadelphia, completing a paediatric infectious disease research fellowship at Johns Hopkins in 2007.
He is currently an assistant professor of pediatric infectious diseases at The Johns Hopkins School of Medicine.
Dr. Milstone’s research interests include the epidemiology and prevention of hospital acquired infections and multi-drug resistant organisms in children.