Chlorhexidine Bathing for Candida auris Decolonization among Adult Patients in Healthcare Settings: Protocol for a Systematic Review and Meta-Analysis

Background Candida auris (C. auris) poses a significant threat in healthcare settings, characterized by its high morbidity and mortality rates. While the use of chlorhexidine bathing has been suggested as a potential strategy for C. auris decolonization in adult patients within healthcare settings, a comprehensive and systematic evaluation of its effectiveness and associated outcomes is notably lacking. Aim This study seeks to systematically assess the effectiveness of daily chlorhexidine bathing for Candida auris decolonization in adult patients within healthcare settings. The study’s primary objectives are to evaluate the impact of this intervention on reducing colonization rates, infection occurrences, and outbreak incidences, while concurrently evaluating any associated adverse events. The study’s secondary objectives are to identify adverse events, and to explore and quantify the effect sizes of potential risk factors, if identified, that may influence the outcomes of chlorhexidine bathing for C. auris decolonization. Methods and Analysis In adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines, this protocol outlines the methodology for our systematic review and meta-analysis. The study commenced with an extensive presearch conducted from June to August 2023 on PubMed, followed by searches across other three key databases: Embase, Web of Science, and Scopus, in September 2023. The systematic search will encompass all available years of publication without applying any publication date filters. Records located in the literature search will be uploaded to the systematic review software Covidence to facilitate deduplication, blinded screening, and the selection of eligible studies. Two independent reviewers will rigorously screen records, extract data, and perform risk of bias assessments, with a third researcher resolving conflicts. The results will be synthesized narratively in summary tables, with the potential for meta-analysis contingent upon the findings, focusing on the effectiveness and adverse events of daily chlorhexidine bathing for C. auris decolonization in adult patients within healthcare settings. Additionally, we will investigate whether certain risk factors, if identified, have an impact on the outcomes by quantifying their effect sizes. Ethics and Dissemination The ethical framework of this systematic review obviates the need for ethics approval, as it relies exclusively on published research. The outcomes of this study will be disseminated via publication in a peer-reviewed journal, shared with stakeholders, and made publicly accessible. PROSPERO Registration CRD42023459048.