背景：醫療照護相關感染(healthcare-associated infections, HAIs)為一項全球性的問題，尤其對免疫功能低下且經常需要侵入性手術的癌症病人影響最深，會導致癌症病人的發病率和致死率。因此，提供有效的預防策略，對於減少癌症患者HAIs的影響及發病率至關重要。雖然研究認為氯己定葡萄糖酸鈣(chlorhexidine gluconate, CHG)擦澡有效降低大量照顧環境下的感染風險，但目前並沒有足夠證據指出此方法可有效適用於各年齡層之癌症患者。
目的：本研究旨在探討CHG擦澡對減少癌症患者醫療相關感染之影響。
研究方法：在五個電子數據庫以及其他包括ClinicalTrials.gov 和grey literature sources等資料來源進行系統文獻搜尋。納入的研究包括隨機對照試驗、準實驗研究、前瞻性世代研究和介入方法研究，評估癌症患者使用CHG 擦澡相比於常規護理擦澡於降低感染風險之效果。主要結果指標為HAIs常見的中心靜脈導管相關血流感染（central line-associated bloodstream infection, CLABSIs），次要結果指標則為多重抗藥性微生物（multidrug-resistant organisms, MDROs）。研究品質是由3名評審作者使用標準化工具進行評讀。
結果：包含五項系統文獻回顧研究以及四項綜合分析研究。研究結果表明，癌症患者每日使用氯己定葡萄糖酸鈣(CHG)擦澡對減少醫療相關感染無顯著相關。而在整合分析結果顯示，對於降低CLABSIs無顯著相關（RR = 1.40，95% CI：0.73 - 2.68）。此外，在預防MDROs的成效上，對有抗藥性菌株移生的抗萬古黴素腸球菌(vancomycin-resistant Enterococcus, VRE)無顯著降低（RR = 0.75，95% CI：0.40 - 1.42）。而抗藥性的金黃色葡萄球菌 (methicillin-resistant Staphylococcus aureus, MRSA) 發生率的研究資料有限，因此無法確定CHG之介入成效。
結果：從我們分析研究中得到的證據無強烈證據支持，癌症患者使用 CHG擦澡對減少HAIs發生，尤其在CLABSIs、有抗藥性菌株移生的VRE和 MRSA 發病率方面無顯著效果。期盼未來能有更多大樣本研究探討以及進行更多標準化方法驗證成效。另外，臨床醫師在決定病人是否使用CHG擦澡時，亦應考量患者族群及狀況。
關鍵詞：癌症、免疫功能低下、氯己定葡萄糖酸鈣、擦澡、醫療照護相關感染

Background: Healthcare-associated infections (HAIs) present a global challenge, particularly affecting cancer patients who have compromised immune systems and frequent exposure to invasive procedures. Central line-associated bloodstream infections (CLABSIs) and multidrug-resistant organisms (MDROs) contribute to the morbidity and mortality of cancer patients. Effective prevention strategies are vital for minimizing effects and incidence of HAIs in this population. Although studies suggest the efficacy of chlorhexidine gluconate (CHG) bathing in reducing infection risk in intensive care settings, there is currently insufficient evidence regarding its effectiveness among all-age cancer patients.
Aim: This study aims to investigate the impact of chlorhexidine gluconate bathing on reducing healthcare-associated infections in cancer patients.
Methods: A systematic literature search was conducted across five electronic databases, supplemented by ClinicalTrials.gov and grey literature sources. Included studies consisted of randomized controlled trials, quasi-experimental studies, prospective cohort studies, and intervention method studies, assessing the effect of CHG bathing compared to usual care bathing in reducing infection risk among cancer patients. The primary outcome measure was central line-associated bloodstream infection (CLABSI), and the secondary outcome measure was multidrug-resistant organisms (MDROs). Study quality was assessed independently by three reviewers using standardized tools.
Results: The systematic review included five studies, and the meta-analysis comprised four studies. The findings suggest that daily CHG bathing intervention may not significantly reduce hospital-acquired infections among cancer patients. Pooled analysis demonstrated no significant reduction in CLABSI rates (RR = 1.40, 95% CI: 0.73 - 2.68). Furthermore, there was no significant reduction in vancomycin-resistant Enterococcus (VRE) colonization (RR = 0.75, 95% CI: 0.40 - 1.42). Limited data were available regarding methicillin-resistant Staphylococcus aureus (MRSA) incidence rates, making the effectiveness of CHG intervention uncertain.
Conclusion: The current evidence does not strongly support the significant effectiveness of CHG bathing intervention in reducing hospital-acquired infections, specifically CLABSIs, VRE colonization, and MRSA incidence, among cancer patients. Further research with standardized methodologies and larger sample sizes is necessary to establish more conclusive evidence. Clinicians should consider the context and patient population when deciding on the implementation of CHG bathing intervention in practice.
Keywords: "Cancer*" OR “Immunocompromised" AND "Chlorhexidine*" AND "Bath*" AND "Hospital infection" OR "Cross Infection."

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