Chlorhexidine bathing decreases hosp-acq infection - page 3

Thought you all would be interested in this paper, especially those who prefer soap and water even when the hospital protocol is to use chlorhexidine. Effect of Daily Chlorhexidine Bathing... Read More

  1. Visit  morte profile page
    0
    Try googling antibacterial+soap+super+bugs......
    Quote from SummitRN
    It is important to understand the COMPLETELY DIFFERENT MECHANISMS by which antibiotics and disinfectants work, and how MDROs develop. You seriously need to review these basic concepts. This is basic nursing fundamentals and pharm 101.

    By your logic we'd better stop using bleach... we don't treat patients with PO bleach... or IV chlorhexidine.
  2. Visit  Enthused RN profile page
    0
    Thanks for the article! At school, my group is researching ways to lower CLABSI rates and we have been thinking about CHG baths in addition to several other methods. This is helpful.
  3. Visit  morte profile page
    0
    23% of small, is..very small. Perhaps if the handwashing was better, it would not be necessary?
    Quote from GrnTea
    Thought you all would be interested in this paper, especially those who prefer soap and water even when the hospital protocol is to use chlorhexidine.
    MMS: Error



    Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection


    Michael W. Climo, M.D., Deborah S. Yokoe, M.D., M.P.H., David K. Warren, M.D., Trish M. Perl, M.D., Maureen Bolon, M.D., Loreen A. Herwaldt, M.D., Robert A. Weinstein, M.D., Kent A. Sepkowitz, M.D., John A. Jernigan, M.D., Kakotan Sanogo, M.S., and Edward S. Wong, M.D.
    N Engl J Med 2013; 368:533-542February 7, 2013DOI: 10.1056/NEJMoa1113849
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    AbstractArticleReferences
    BACKGROUND

    Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs).
    Full Text of Background...


    METHODS

    We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine-impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis.
    Full Text of Methods...


    RESULTS

    A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P=0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period.
  4. Visit  GrnTea profile page
    1
    Quote from BrandonLPN
    Well, I come from a LTC perspective. .... Our residents need to be clean and comfortable. Strict asepsis isn't necessary in their day to day lives any more than it is in ours.

    Acute care is obviously a whole other kettle of fish, but in LTC we do many things that probably aren't 100% best possible evidence based practice.

    I understand that carb counting is better practice for insulin administration, but monitoring and controlling what our residents eat to that extent is too invasive. There's a reason carb counting is rare in LTC. It's not because we're resistant to change, it's just that it's not necessary or even desirable.

    I understand that best practice dictates levothyroxine be giving on an empty stomach. But I'm not gonna wake a 90 year old up at 5am every single day to give it. Give it at HS. No, their stomachs aren't completely empty, but they're empty enough.

    I know there's a lot of nurses who resist new techniques even in the face of evidence and established studies. They cling to old ways more out of tradition than out of critical thinking. This is wrong.

    But I also know some nurses who think every "best practice" policy should be implemented across the board in every setting of nursing. This is wrong, too.

    You cannot be serious. It surely is not. Now that LTC facilities get admissions from hospitals all the time (gee, I wonder when that started?) the chance of importing resistant bugs is just as high as it is in a hospital. Best practices are not optional, they are our duty under the ANA Scope and Standards of Nursing Practice; you can look it up. If you, an LPN, cannot see your way clear to do them, then the RN who delegates to you is responsible to see that you do.

    Just because the facility is the resident's home does not mean at all that it's like your home, where the bugs you and your family are exposed to are mostly ... yours. These residents have diminished immune systems, too.

    I would dearly love to have a medical record or published words that says something like your quote above it to review in a legal case. You think that evidence-based practice is optional? You think that you can choose to give a med when you want to when it's specifically indicated to give at a different time or setting? You don't bother with looking at nutritional levels when caring for diabetics? Oh, boy. My spidey-sense feels the attorney salivating right now. You would be sooo going down. This is irresponsible in the extreme.
    ♪♫ in my ♥ likes this.
  5. Visit  GrnTea profile page
    1
    Quote from CVmursenary
    I question "evidence based practice". It is used by companies to sell products to a hospital. Why not just bathe patients with soap and water and cleanse around an incision or break in the skin with chlorahexadine.

    Is it all evidence-based practice you "question," or this one in particular?

    If you read the study, you will note that bathing with this product (and the study was not sponsored by a manufacturer) decreased infection significantly as described. The effect was ascribed to the idea that the body's entire bacterial load was decreased, thus decreasing the number of bacterial agents available to contaminate anything.

    Chlorhexidine has been used around line sites for ages; this represented an improvement in care. Did you read this study?
    ♪♫ in my ♥ likes this.
  6. Visit  morte profile page
    0
    I repeat, 23 % of small, is,.....very small.
    Quote from GrnTea

    Is it all evidence-based practice you "question," or this one in particular?

    If you read the study, you will note that bathing with this product (and the study was not sponsored by a manufacturer) decreased infection significantly as described. The effect was ascribed to the idea that the body's entire bacterial load was decreased, thus decreasing the number of bacterial agents available to contaminate anything.

    Chlorhexidine has been used around line sites for ages; this represented an improvement in care. Did you read this study?
  7. Visit  BrandonLPN profile page
    0
    Quote from GrnTea

    You cannot be serious. It surely is not. Now that LTC facilities get admissions from hospitals all the time (gee, I wonder when that started?) the chance of importing resistant bugs is just as high as it is in a hospital. Best practices are not optional, they are our duty under the ANA Scope and Standards of Nursing Practice; you can look it up. If you, an LPN, cannot see your way clear to do them, then the RN who delegates to you is responsible to see that you do.

    Just because the facility is the resident's home does not mean at all that it's like your home, where the bugs you and your family are exposed to are mostly ... yours. These residents have diminished immune systems, too.


    I would dearly love to have a medical record or published words that says something like your quote above it to review in a legal case. You think that evidence-based practice is optional? You think that you can choose to give a med when you want to when it's
    specifically indicated to give at a different time or setting? You don't bother with looking at nutritional levels when caring for diabetics? Oh, boy. My spidey-sense feels the attorney salivating right now. You would be sooo going down. This is irresponsible in the extreme.
    I think you misunderstood.

    I give meds at scheduled times.... We don't schedule routine meds at 6am here in most cases.

    As for carb counting, well, you have to understand our residents get food from outside sources. They go out to eat with family. They have food brought in. Even the diabetics.

    It seems you thought I was refusing to count carbs as ordered or something. It's just not policy here. We don't ebb do sliding scales. We give a scheduled dose of novolg with meals
    and hold it if the BS is too low or the res isn't eating.

    If the doctor DID order a carb counting dosage regimen, of COURSE I'd follow it.

    And you think wipe baths should replace showers? I'm sorry, my residents enjoy their showers. To deny them this seems cruel. Every LTC facility I've seen only offers showers once or twice a week. They need that shower.
  8. Visit  BrandonLPN profile page
    1
    What I meant was, you can't expect to have the same infection control policies in a nursing home as you have in ICU.
    ♪♫ in my ♥ likes this.
  9. Visit  ♪♫ in my ♥ profile page
    0
    Quote from morte
    Perhaps if the handwashing was better, it would not be necessary?
    Perhaps...

    However, hand hygiene has been a front-burner topic for many years; one could argue that, barring introduction of some disruptive technology, it's matured and is not likely to improve substantially from where it presently is...

    And yet the problem with MDROs, CLABSI, CAUTI, etc is increasing all the time.

    Twenty percent is not dramatic but it's not small... it's incremental.
  10. Visit  morte profile page
    0
    we have heard/seen here on AN. that short staffing has lessened hand washing....and 20% sounds like a lot, but that is 20% of less than 1% of patient days....as i said 23% of small (actuallyvery small) is very, perhaps even very very, small.

    ptive technology, it's matured and is not likely to improve substantially from where it presently is...

    And yet the problem with MDROs, CLABSI, CAUTI, etc is increasing all the time.

    Twenty percent is not dramatic but it's not small... it's incremental.[/QUOTE]
  11. Visit  Vespertinas profile page
    1
    One of the advantages that CHG has over regular soap and water (besides its bactericidal properties) is that it continues to inhibit bacteria for hours after application (residual action).

    Also, I believe 23% is actually a huge reduction. In another thread, we discussed VTE risk where "high risk" meant 6% chance of developing VTE. Suddenly quality watchers and hospitals everywhere see it as monumentally important to start prophylactically treating everyone under the sun for VTE because of a little 6% chance. That's because it's cheaper to throw around heparin and TEDs than deal with the consequences of a handful of people with a new clot. I imagine same goes for a little pink soap versus a multi-drug resistant infection.
    GrnTea likes this.
  12. Visit  SummitRN profile page
    1
    I'll add that we shouldn't be using CHG wipes on the face/mucous membranes and should use moisturizers (as they did in the study).

    Quote from morte
    Try googling antibacterial+soap+super+bugs......
    You brought up the worry, the burden of proof is on you.


    I am aware of some research for 2007 and 2008 that looked at quaternary ammonia compounds like triclosan found in consumer antibacterial soaps had no advantage over normal soap. A few studies covered the worry you brought up. These studies were low power studies and mostly statistical insignificant. The results of these studies often had no meaningful results but the authors remained concerned largely based on theory combined with the argument that biocides don’t have a proven need or even proven effectiveness in the home. The opposite is the case in the hospital. There is both a proven effect and a proven need for these biocides. Therefor, we should not recoil in fear of possibilities of CHG being a theoretical progenitor or promoter of "super bugs" when it is nothing like the home use QAC biocides that you probably heard referenced in some story on CNN 5 years ago.
    GrnTea likes this.
  13. Visit  morte profile page
    0
    actually someone else brought it up. I googled, gave you the words I googled, figured you could do that much...I don't watch TV, s
    Quote from SummitRN
    I'll add that we shouldn't be using CHG wipes on the face/mucous membranes and should use moisturizers (as they did in the study).


    You brought up the worry, the burden of proof is on you.


    I am aware of some research for 2007 and 2008 that looked at quaternary ammonia compounds like triclosan found in consumer antibacterial soaps had no advantage over normal soap. A few studies covered the worry you brought up. These studies were low power studies and mostly statistical insignificant. The results of these studies often had no meaningful results but the authors remained concerned largely based on theory combined with the argument that biocides don’t have a proven need or even proven effectiveness in the home. The opposite is the case in the hospital. There is both a proven effect and a proven need for these biocides. Therefor, we should not recoil in fear of possibilities of CHG being a theoretical progenitor or promoter of "super bugs" when it is nothing like the home use QAC biocides that you probably heard referenced in some story on CNN 5 years ago.
    Last edit by Esme12 on Mar 8, '13

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