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This is a discussion on Chlorhexidine bathing decreases hosp-acq infection in Nursing News, part of General Nursing ... Thought you all would be interested in this paper, especially those who prefer soap and water even...by GrnTea Mar 5Thought 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 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
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...
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...
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.
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- Mar 5 by redhead_NURSE98!Ick, it's so sticky though!!! (Still use them when they're ordered though)
- Mar 5 by ScottE,RNQuote from redhead_NURSE98!Once it completely dries the stickiness goes away based on what I've seen.Ick, it's so sticky though!!! (Still use them when they're ordered though)
- Mar 5 by nrsang97Our handsoap used to have cholrahexadine in it and it was so incredibly drying. I couldn't imagine being bathed in that.
- Mar 5 by crazy&cuteRNThanks for the article. I have to admit I despise those bath wipes. I remember being a tech in the ICU years ago and we used good old fashion wash clothes, towels, and soap and warm water. Therefore, I was shocked when I saw these wipes when I started working in ICU last year.
I'm so glad there is evidenced based practice on this so that everyone would be educated that these wipes are better for the patient.
- Mar 5 by Rhi007Good grief!!!! Imagine the skin lotion you would go through
- Mar 5 by BrandonLPNCouldn't they just make a bottle of body wash soap with chlorhexidine in it? That way one could still give a bed bath with soap and water and wash cloths. I still don't like the idea of giving a bed bath with just disposable wipes.
- Mar 5 by DesireeRN2011I work in the OR, so there is no real way around chlorhexidine. Obviously, if the patient has an allergy that is one thing, but it's literally everywhere in our world. For OR staff, there is really no getting away from chlorhexidine - our approved soap to scrub with has chlorhexidine, and the alternate is the Avagard waterless scrub solution (alcohol and chlorhexidine). Most of our nurses (RN) can circulate and scrub, but I suppose the few that don't scrub could theoretically avoid it. But when I circulate, there's only so many times I can use the alcohol handwash before I feel like I need to "wash" with soap and water. Plus, I always wash with the CHG soap and water before I leave, either going to lunch or at the end of the day.
For me it's days I use the waterless scrub solution that my hands are very dry... The alcohol waterless wash is what I find sticky, and it was that way for me as an assistant, as a nursing student and when I worked the floor - the dryness from the waterless handwash. It's also what dries my hands out so badly. At one point as an RN working a med surg unit my hands were cracked and bleeding from only a few uses of the hand sanitizer, but it could be me.
I don't see why chlorhexidine would be an issue for patients to bathe with, provided that skin care also includes the use of lotion too. Also - chlorhexidine is contraindicated for contact with mucous membranes, and the eyes... But it's easy to see why for line placement (IV/central line etc) chlorhexidine is the prep of choice...we also use CHG soaked discs to put around central lines, where the lumen leaves the body, which totally makes sense... Obviously it makes sense used as surgical prep...
- Mar 5 by Sweet_Wild_RoseQuote from BrandonLPNThey do! It's what we do with our preoperative patients- bath with chlorhexidine gluconate soap in water with washcloths the night before and again while in the preop unit. It is, however, rather expensive. Most of our patients' insurance will cover it when picked up at a pharmacy for the one the night before, and there is no additional cost for the soap provided in preop.Couldn't they just make a bottle of body wash soap with chlorhexidine in it? That way one could still give a bed bath with soap and water and wash cloths. I still don't like the idea of giving a bed bath with just disposable wipes.
- Mar 5 by TiffyRNSo chlorhexidine is drying. . .
If I was a patient, I would prefer some dry itchy skin over a possibly fatal infection, or extended hospital stay and disability. But that's just me I guess.
Our unit bathes infants with chlorhexidine for MRSA decolonization. There are precautions so it's not used on too small infants with immature skin. I scrub them, then rinse them well, then coat them in lotion. The lotion is CHG compatible and it smells decent to boot. I use it even on kids that get regular baths.
I just wrote a research paper about chlorhexidine and learned many great things about it.
One hospital I worked at used to make the nurses caring for patients with MRSA to wash their hands with hand soap with a squirt of betadine, talk about drying!!!