CLIP-ID: Decolonisation study for the prevention of catheter-associated sepsis

Dear CLIP-ID participants,

We would like to thank all the participating study divisions for their commitment, dedication, support and excellent cooperation. Without you, such epidemiological studies, evidence-based medicine and thus improved patient care would not be possible.

Aims of the study and summarised results

The aim of this three-arm cluster-randomised multicentre decolonisation study was to compare three different strategies for the daily body washing of patients in intensive care units with and without antiseptic products, with regard to the incidence of central venous catheter (CVC)-associated sepsis and multidrug-resistant pathogens (MDROs) acquired on the ward. For this purpose, intensive care units in Germany and Austria were recruited. All participating wards were part of the ITS-KISS network, the hospital infection surveillance system for intensive care units. They routinely documented the frequency of CVC-associated sepsis and MRP. The 72 participating intensive care units were randomly assigned to one of the three groups:

  • Intervention group 1: Washing of all patients with 2% chlorhexidine digluconate (CHG) wipes (SAGE Products) and staff training,
  • Intervention group 2: Washing of all patients with 0.08% octenidine wash gloves (Schülke&Mayr) and training of staff,
  • Control group: Washing patients with soap and water without the addition of antiseptic substances and staff training. After the intervention (from February 2018), the control group (ITS) was provided with CHG wipes or octenidine wash gloves for 12 months.

The main analysis showed that daily antiseptic washes with 2% chlorhexidine-containing wipes or 0.08% octenidine washcloths had no significant preventive effect on CVC-associated sepsis rates compared to soap and water washes. However approximately 40% fewer cases of sepsis were observed in the CLIP-ID study than originally assumed for the calculation of  the number of cases. This means that the CLIP-ID trial is likely to be underpowered. The number of infections observed was too low to be statistically significant.

Denkel LA, Schwab F, Clausmeyer J, Behnke M, Golembus J, Wolke S, Gastmeier P, Geffers C. Effect of antiseptic bathing with chlorhexidine or octenidine on central line-associated bloodstream infections in intensive care patients: a cluster-randomized controlled trial. Clin Microbiol Infect. 2022 Jun;28(6):825-831. doi: 10.1016/j.cmi.2021.12.023. Epub 2022 Jan 11. PMID: 35031487.

Yet the before-and-after analysis of the CLIP-ID data also shows that intensive care units with high initial rates (≥ 0.8 CVC-associated septicaemia / 1000 CVC days) in particular can reduce the infection rate by using antiseptic washes with 2% chlorhexidine-containing wipes. Antiseptic washes with 0.08% octenidine wash gloves showed no preventive effect on the sepsis rate in this analysis. The manuscript on the results of this before-and-after analysis is currently under evaluation.

In the CLIP-ID study, the 12-month intervention with chlorhexidine and octenidine had no effect on the susceptibility of clinical bacterial isolates to these antiseptic substances. The manuscript reporting these results is currently under review.

The influence of climatic factors on wound infection and sepsis rates was analysed in the publications below.

Aghdassi SJS, Gastmeier P, Hoffmann P, Schwab F. Increase in surgical site infections caused by gram-negative bacteria in warmer temperatures: Results from a retrospective observational study. Infect Control Hosp Epidemiol. 2021 Apr;42(4):417-424. doi: 10.1017/ice.2020.463. Epub 2020 Oct 7. PMID: 33023687.

Schwab F, Gastmeier P, Hoffmann P, Meyer E. Summer, sun and sepsis-The influence of outside temperature on nosocomial bloodstream infections: A cohort study and review of the literature. PLoS One. 2020 Jun 19;15(6):e0234656. doi: 10.1371/journal.pone.0234656. PMID: 32559761; PMCID: PMC7304998.

Aghdassi SJS, Schwab F, Hoffmann P, Gastmeier P. The Association of Climatic Factors with Rates of Surgical Site Infections: 17 Years' Data From Hospital Infection Surveillance. Dtsch Arztebl Int. 2019 Aug 5;116(31-32):529-536. doi: 10.3238/arztebl.2019.0529. PMID: 31554540; PMCID: PMC6783630.

Further publications on the CLIP-ID study are currently in preparation.

For further questions and additional information, please contact the head of the study, Prof. Dr. med. Christine Geffers or Dr. rer. nat. Luisa A. Denkel.

Tel:  +49 30 – 450 577 612

Fax: +49 30 – 450 577 920

E-Mail: christine.geffers@charite.de | luisa.denkel@charite.de