Reducing Bio-burden and Healthcare Associated Infection Risk Among Hospitalized Patients: Adoptability of Chlorhexidine Gluconate Bathing Among Non-ICU Patients
Daily CHG application has been shown to reduce all-cause and central line associated bloodstream infections in intensive care units (ICUs) where most patients are sedated and bathing is done by nursing staff. Recent literature suggests similar gains may be possible in non-ICU settings. No data are available on successful adoptability of daily CHG bathing in awake, non-ICU patients, some of whom self-bathe. We describe patient-reported CHG bathing practices and compliance in an academic hospital where daily 2% CHG bathing was implemented hospital-wide.
We conducted a two-part, verbally administered survey of a convenience sample of adult patients in non-ICU medical and surgical wards from Nov 2013 - Mar 2014. Surveys included 53 questions for self-bathers and 51 questions for those bathed by nursing staff. We excluded psychiatric, rehabilitation, and peripartum wards.
153 adults completed the surveys. 37% (n=56) self-bathed with CHG cloths while the remainder were bathed by nursing staff. Among self-bathers, the following proportions received proper instructions: to massage CHG onto their skin (48%), to allow CHG to air dry (66%), and to use all six cloths (65%). Among self-bathers who had a temporary indwelling device (central venous catheter (CVC), drain, urinary catheter) or wound, only 43% and 14%, respectively, were informed that CHG should be used to clean those areas. Among patients receiving assisted baths, 67% had CHG massaged onto their skin, 83% allowed CHG to air dry, and 70% had all six cloths used on their body. Among assisted patients with a device or a wound, 66% and 39%, respectively, reported that CHG was used to clean those areas.
Conclusion: Expected gains in reducing healthcare associated infections with CHG in non-ICU inpatients necessitates proper application, particularly in body areas at highest risk for infection. Instructions to patient self-bathers on proper CHG application was poor or poorly retained, especially for high risk areas such as devices and wounds. Even with nursing assistance, over 30% and 60% patients did not report proper application of CHG to devices and wounds, respectively. Successful hospital-wide adoption of daily CHG bathing requires significant patient and nursing education.
S. K. Gohil,
E. Kim, None
J. Chang, None
S. S. Huang, Sage Products: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed Product
Molnlycke: Conducting a clinical trial for which contributed product is being provided to participating hospitals, Contributed product