221. Efficacy and Cost of Basinless Baths Compared to Chlorhexidine Bathing to Reduce Hospital Acquired Infections (HAI)
Session: Poster Abstract Session: Criticare, HAIs: Pneumonia and Chlorhexidine
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA poster 2013.MM.pdf (531.7 kB)
  • Background: Bath basins may harbor organisms that can cause infections. Bathing with chlorhexidine (CHG) impregnated wipes may reduce the risk of hospital acquired infections (HAIs). We compared the effects and cost of basinless bathing (BB) using foam no-rinse body cleanser versus bathing with CHG wipes in reducing catheter associated urinary tract infections (CAUTI) and central line associated bloodstream infections (CLABSIs) in critically ill adults.

    Methods: The study was conducted in an academic medical center in 4 adult intensive care units (ICUs). The average daily census was 48 patients. The study had three phases, each 3 months in duration. Phase 1:  Baseline, measured HAI rates with bathing using a basin. Phase 2: All patients were bathed using BB.  Phase 3: Patients were randomized to CHG wipes or BB. 96% of all critical care nurses and ancillary staff were educated on BB and CHG wipe bathing protocols.  CLABSI and CAUTI rates were tracked by infection prevention specialists. Rates were defined as infections occurring during the ICU hospitalization that were associated with a device. Cost was assessed based on the products being used and did not include staff time.

    Results: An average of 4320 patient bathing episodes were observed in each phase of the study. Mean central line days = 2372 and mean indwelling urinary catheter days = 2994.  A reduction in both CLABSI and CAUTI rates was found when bathing practices were standardized to BB.  CAUTI decreased from 1.43 to 0.97 (O.R= 0.63) with BB. When CHG was added, CAUTI rates decreased to 0 (O.R<0.45). CLABSI rates were reduced with BB from 1.59 to 1.11 (O.R. = 0.70).  Less impact  on CLABSI rates was seen with CHG bathing (rate 2.06, O.R. = 0.74).  No adverse skin reactions were reported in the study. The cost of BB was $1.35/day. The cost for CHG bathing was $5.78/day. 

    Conclusion: Standardized basinless bathing decreased rates of CLABSI and CAUTIs.  CHG bathing may further reduce skin flora positively impacting a reduction in HAIs. In this study with an average of 1440 bathing episodes/month, cost for BB was $1944 compared to $8323 for CHG. Given the high cost associated with CAUTIs and CLABSIs, the four-fold increase in cost for CHG bathing may justify the use of this product in individuals with devices but may not be economical for bathing of all patients.

    Mary Beth Flynn Makic, RN, PhD, CNS, CCNS1, Linda Burton, RN, CIC2, Teresa Hulett, RN2, Kathleen Schomer, RN, CIC2 and Michelle Barron, MD3, (1)Critical Care, University of Colorado Hospital, Aurora, CO, (2)Infection Prevention and Control, University of Colorado Hospital, Aurora, CO, (3)Internal Medicine/Infectious Diseases, University of Colorado Denver, Aurora, CO

    Disclosures:

    M. B. Flynn Makic, None

    L. Burton, None

    T. Hulett, None

    K. Schomer, None

    M. Barron, None

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