Chlorhexidine Bathing to Reduce Central Venous Catheter-associated Bloodstream Infection: Impact and Sustainability

Montecalvo, Marisa A.; McKenna, Donna; Yarrish, Robert; Mack, Lynda; Maguire, George P.; Haas, Janet P.; DeLorenzo, Lawrence; Dellarocco, Norine; Savatteri, Barbara; Rosenthal, Addie; Watson, Anita; Spicehandler, Debra; Shi, Qiuhu; Visintainer, Paul; Wormser, Gary P.

doi:10.1016/j.amjmed.2011.10.032

Cited by 60 publications

(32 citation statements)

References 11 publications

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“…The quality and skin microbial scores were similar, but the prepackaged bed-bath resulted in the use of significantly less product, a reduction in time to gather supplies and perform the bath, lower cost, and higher nurse satisfaction. [20][21][22][23] However, the results in this study revealed that water was not changed during most traditional baths, and washcloths were reused from contaminated regions.…”

Section: 22mentioning

confidence: 69%

“…Soap-andwater basin bed-bath was compared with nonmedicatedprepackaged bed-bath in many studies. [20][21][22][23] Forty patients received both types of baths on different days in a surgical, medical, and cardiothoracic ICU. The quality and skin microbial scores were similar, but the prepackaged bed-bath resulted in the use of significantly less product, a reduction in time to gather supplies and perform the bath, lower cost, and higher nurse satisfaction.…”

Section: 22mentioning

confidence: 99%

“…Studies reported that wash water should be changed whenever it becomes too soapy, cold or dirty, and should always be changed after washing the genitals, buttocks and anal area. [17][18][19][20][21][22][23] In the current study, soap and water were used for bed-bath patients in ICUs. This result may be attributed to that nurses used to perform bed-bath from their nursing schools using soap and water.…”

Section: 22mentioning

confidence: 99%

“…[25] Recent evidence supports that chlorhexidine, impregnated cloths in reducing pathogen transmission. [10,[21][22][23][26][27][28][29][30][31] A comprehensive study examined VRE colonization rates with three types of bed-bath (soap and water, non-medicated prepackaged bed-bath, and CHG-impregnated prepackaged cloths). The CHG-impregnated cloths produced colony count reduction on the skin when compared with soap-and-water bed-bath and a significant reduction in CLABSIs was demonstrated with CHG bed-bath.…”

Section: 22mentioning

confidence: 99%

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Examining bed-bath practices of critically ill patients

El-Soussi

Asfour

2016

JNEP

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Introduction: Daily bed-baths are usually provided for most critically ill patients to improve patient hygiene, promote comfort and improve health outcomes. Critically ill patients are at greater risk for skin colonization and infection with multidrug-resistant organisms. Therefore, it is important to provide critically ill patient with effective personal hygiene especially bed-bath as poor hygiene may increase the risk of infection. The decision for bed-bath depends on the judgment of the caring nurse. The aim of this work was to describe bed-bath practices in intensive care units. Methods: A descriptive design was used. Sixty intensive care unit nurses were involved. Tool: "Bed-bath practices of critically ill patients' assessment sheet" was used to collect data. Results: More than three quarters of nurses, 79% had improper bed-bath practices. The gap for safe bed-bath practices between nurses' current bed-bath practices and the bed-bath evidence-based recommendations is wide (83%). Nurses' self-reported reasons that hinder safe bed-bath practices were financial resources, followed by lack of equipment, no policy, lack of knowledge, and workload. Conclusions: Although, bed-bath is a routine nursing procedure, critical care nurses in the current study had poor skills and knowledge regarding it. The factors affecting bed-bath practice are financial resources, lack of equipment, no policy, lack of knowledge and workload. In-service training program should be conducted for nurses regarding putting priority of nursing care, determining timing and frequency for the bed-bath.

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Section: 22mentioning

confidence: 69%

Section: 22mentioning

confidence: 99%

Section: 22mentioning

confidence: 99%

Section: 22mentioning

confidence: 99%

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Examining bed-bath practices of critically ill patients

El-Soussi

Asfour

2016

JNEP

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“…In 2012, Montecalvo and associates published a prospective, 3-phase multiple-hospital study in which the intervention progressed from bathing with soap and water or nonmedicated cloths to bathing with 2% CHG cloths to continued CHG bathing without oversight by research personnel. Compared with preintervention, CHG bathing was associated with significant reductions in CLABSIs from 6.4 per 1000 catheter-days to 2.6 per 1000 catheter-days (P < .001) [13]. Climo et al performed a nonblinded cluster-randomized crossover study on the incidence of hospital-acquired BSIs and found a 28% reduction in the overall rate of hospital-acquired BSIs with CHG bathing vs nonmedicated cloths [14].…”

Section: Discussionmentioning

confidence: 99%

Closing the Translation Gap: Toolkit-based Implementation of Universal Decolonization in Adult Intensive Care Units Reduces Central Line–associated Bloodstream Infections in 95 Community Hospitals

et al. 2016

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Background. Challenges exist in implementing evidence-based strategies, reaching high compliance, and achieving desired outcomes. The rapid adoption of a publicly available toolkit featuring routine universal decolonization of intensive care unit (ICU) patients may affect catheter-related bloodstream infections.Methods. Implementation of universal decolonization-treatment of all ICU patients with chlorhexidine bathing and nasal mupirocin-used a prerelease version of a publicly available toolkit. Implementation in 136 adult ICUs in 95 acute care hospitals across the United States was supported by planning and deployment tactics coordinated by a central infection prevention team using toolkit resources, along with coaching calls and engagement of key stakeholders. Operational and process measures derived from a common electronic health record system provided real-time feedback about performance. Healthcare-associated central line-associated bloodstream infections (CLABSIs), using National Healthcare Safety Network surveillance definitions and comparing the preimplementation period of January 2011 through December 2012 to the postimplementation period of July 2013 through February 2014, were assessed via a Poisson generalized linear mixed model regression for CLABSI events.Results. Implementation of universal decolonization was completed within 6 months. The estimated rate of CLABSI decreased by 23.5% (95% confidence interval, 9.8%-35.1%; P = .001). There was no evidence of a trend over time in either the pre-or postimplementation period. Adjusting for seasonality and number of beds did not materially affect these results.Conclusions. Dissemination of universal decolonization of ICU patients was accomplished quickly in a large community health system and was associated with declines in CLABSI consistent with published clinical trial findings.

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