Chlohexidine bathing to reduce catheter-related blood stream infections

NeosynephRN · Jun 1, 2009

We are currently bathing all our patients upon admission to the unit in the chlorihexidine solution, then also on M-W-F. We have not been doing it long enough to correlate any reduction in actual infection rates, but it will be interesting to see what happens.

WalkieTalkie, RN · Jun 1, 2009

We are doing the same M-W-F bathing and at some point we will start daily baths to see if it reduces infection rates.

PICC ACE · Jun 2, 2009

Thanks for the replies,c0n.. and Neo..

Why the MWF Friday schedule? Any specific concerns using it daily?

TY

iluvivt, BSN, RN · Jun 2, 2009

I would be happy if all nurses would do proper dressing changes,cap changes.proper cap scrubbing before use and site monitoring and notify MDs and nurses when they are not performing maximal barrier precautions. These are proven methods to reduce CRBSI's..but if CHG bathing also helps I am all for it BUT first we have to improve compliance with site care and cap care and maintaining sterile tubing and etc

WalkieTalkie, RN · Jun 2, 2009

Thanks for the replies,c0n.. and Neo..
Why the MWF Friday schedule? Any specific concerns using it daily?
TY

Not that I know of... eventually we will be rolling out the study to daily usage. I think they are trying to see if M-W-F is sufficient, or if daily bathing prevents more infections. I think it's all part of the data they're wanting to obtain.

mama_d, BSN, RN · Jun 2, 2009

I would be happy if all nurses would do proper dressing changes,cap changes.proper cap scrubbing before use and site monitoring and notify MDs and nurses when they are not performing maximal barrier precautions. These are proven methods to reduce CRBSI's..but if CHG bathing also helps I am all for it BUT first we have to improve compliance with site care and cap care and maintaining sterile tubing and etc

I'm with you there...

For literally months now the "new" protocol has been to use the same secondary tubing for all piggybacks as well as to change the caps after blood draws. EVERY shift I work I go into rooms and see the same thing...multiple empty piggyback bags hanging, each with their own secondary tubing, and caps that have obviously not been changed after blood draws. And it's not like people haven't been educated on it, either; we all had to get signed off on reading the new protocol along with it being posted in multiple high traffic areas of the unit.

We're not using CHG bathing, we're lucky if we can manage to get the day techs to bathe our patients every three or four days. We use dial soap in general (only eleven cents a bar, ya know?).

PICC ACE · Jun 6, 2009

Proper line care and proper site care will go a long way to reduce CRBSI's---this has been well documented and I'm sure that facilities that are ignorant of the CDC guidelines and IHI bundles are in the minority in this country,but even so the incidence of CRBSI's is not zero. Having rates under the NNIS guidelines shouldn't be the goal,ZERO CRBSI's should be the goal. Anything that we can do to get closer to that goal is a good thing,and if CHG bathing can get us closer to that goal,why not consider it? Here's another study just out:

Critical Care Medicine. 37(6):1858-1865, June 2009.

Climo, Michael W. MD; Sepkowitz, Kent A. MD; Zuccotti, Gianna MD, MPH; Fraser, Victoria J. MD; Warren, David K. MD; Perl, Trish M. MD, MSc; Speck, Kathleen; Jernigan, John A. MD; Robles, Jaime R. PhD; Wong, Edward S. MD

Abstract:

Objective: Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream infections (BSI) because of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) among ICU patients.

Design, Setting, and Patients: Six ICUs at four academic centers measured the incidence of MRSA and VRE colonization and BSI during a period of bathing with routine soap for 6 months and then compared results with a 6-month period where all admitted patients received daily bathing with a chlorhexidine solution. Changes in incidence were evaluated by Poisson and segmented regression modeling.

Interventions: Daily bathing with a chlorhexidine-containing solution.

Measurements and Main Results: Acquisition of MRSA decreased 32% (5.04 vs. 3.44 cases/1000 patient days, p = 0.046) and acquisition of VREdecreased 50% (4.35 vs. 2.19 cases/1000 patient days, p = 0.008) following the introduction of daily chlorhexidine bathing. Segmented regression analysis demonstrated significant reductions in VRE bacteremia (p = 0.02) following the introduction of chlorhexidine bathing. VRE-colonized patients bathed with chlorhexidine had a lower risk of developing VRE bacteremia (relative risk 3.35; 95% confidence interval 1.13-9.87; p = 0.035), suggesting that reductions in the level of colonization led to the observed reductions in BSI.

Conclusion: We conclude that daily chlorhexidine bathing among ICU patients may reduce the acquisition of MRSA and VRE. The approach is simple to implement and inexpensive and may be an important adjunctive intervention to barrier precautions to reduce acquisition of VRE and MRSA and the subsequent development of healthcare-associated BSI.

The studies I've mentioned offer promising results and need further replication,but I won't be suprised to see CHG bathing becoming more and more a part of ICU care.

Z.

qcumba · Jun 9, 2009

I'm with you there..
We're not using CHG bathing, we're lucky if we can manage to get the day techs to bathe our patients every three or four days. We use dial soap in general (only eleven cents a bar, ya know?).

I hope I'm misunderstanding you but are you seriously saying your patients only get washed every 3 - 4 days?? if so why?

we wash our patients daily always with CHG, patients who are in isolation get BD washes

wanderlust99 · Jun 18, 2009

My unit uses the chlorhexidine wipes everyday (once every 24 hrs). I like them, it's very quick & easy to give a bath. We use them based on the recent research.

nefarious · Jun 18, 2009

hi. our unit is part of a study of the effectiveness of CHG bath in decreasing hospital-acquired bloodstream infections. we started using it 5 to 6 months ago. since it's still on implementation phase, we don't know its effectivity yet but so far i like it because it's easy and quick to use.

Chisca, RN · Jul 1, 2009

Wash basins are also being implicated as they serve as a reservior for bacteria especially if they are stored so that moisture is left after use.