You get back what you give: Decreased hospital infections with improvement in CHG bathing, a mathematical modeling and cost analysis

Reagan, Kelly A; Chan, David M.; Vanhoozer, Ginger; Stevens, Michael P.; Doll, Michelle; Godbout, Emily; Cooper, Kaila; Pryor, Rachel; Hemphill, Robin R.; Bearman, Gonzalo

doi:10.1016/j.ajic.2019.07.003

Cited by 18 publications

(16 citation statements)

References 12 publications

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“…The findings of this study are supported by robust evidence that have demonstrated the safety and potential benefit of chlorhexidine bathing in critically ill patients [20][21][22]. In this study, the incidence of BSI in the control group was 11.7 per 1000 ECMO catheter days, which was similar to previous reports [4].…”

Section: Discussionsupporting

confidence: 89%

Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study

Yeo

Kim

et al. 2020

Crit Care

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Background Although the prevention of extracorporeal membrane oxygenation (ECMO) catheter-related infection is crucial, scientific evidence regarding best practices are still lacking. Methods We conducted an uncontrolled before-and-after study to test whether the introduction of disinfection with 2% chlorhexidine gluconate (CHG) and 70% isopropyl alcohol (IPA) of the exposed circuits and hub in patients treated with ECMO would affect the rate of blood stream infection (BSI) and microbial colonization of the ECMO catheter. We compared the microbiological and clinical data before and after the intervention. Results A total of 1740 ECMO catheter days in 192 patients were studied. These were divided into 855 ECMO catheter days in 96 patients before and 885 ECMO catheter days in 96 patients during the intervention. The rates of BSI were significantly decreased during the intervention period at 11.7/1000 ECMO catheter days before vs. 2.3/1000 ECMO catheter days during (difference 9.4, 95% confidence interval (CI) 1.5–17.3, p = 0.019). Furthermore, the colonization of the ECMO catheter was similarly significantly reduced during the intervention period at 10.5/1000 ECMO catheter days before vs. 2.3/1000 ECMO catheter days during intervention (difference 8.3, 95% CI 0.7–15.8, p = 0.032). Hospital mortality (41.7% vs. 24%, p = 0.009) and sepsis-related death (17.7% vs. 6.3%, p = 0.014) were also significantly decreased during intervention. Conclusion Extensive disinfection of exposed ECMO circuits and hub with 2% CHG/IPA was associated with a reduction in both BSI and microbial colonization of ECMO catheters. A further randomized controlled study is required to verify these results. Trial registration KCT 0004431

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Section: Discussionsupporting

confidence: 89%

Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study

Yeo

Kim

et al. 2020

Crit Care

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“…Other barriers noted in the literature include a lack of time, lack of motivation, and a lack of perceived importance of CHG bathing in reducing infections [ 16 – 18 ]. A recent mathematical modeling and cost analysis study [ 20 ] showed that increasing CHG bathing compliance from 60 to 90% had the potential to reduce CLABSI incidence by 32%, result in 20 averted infections, save over $815,000, and decrease mortality—saving up to 5 lives. Due to poor adoption of evidence-based CHG bathing practices, nurses are missing opportunities to reduce infection rates in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

“…Other barriers noted in the literature include a lack of time, lack of motivation, and a lack of perceived importance of CHG bathing in reducing infections [16][17][18]. A recent mathematical modeling and cost analysis study [20] showed that increasing CHG bathing compliance from 60 to 90% had the potential to reduce CLABSI incidence by 32%, result in Contributions to the literature Daily chlorhexidine gluconate (CHG) bathing to decrease patients' risk of infection is widely supported in the literature.…”

Section: Introductionmentioning

confidence: 99%

Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

et al. 2021

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Background Central line-associated bloodstream infections (CLABSIs) result in approximately 28,000 deaths and approximately $2.3 billion in added costs to the U.S. healthcare system each year, and yet, many of these infections are preventable. At two large health systems in the southeast United States, CLABSIs continue to be an area of opportunity. Despite strong evidence for interventions to prevent CLABSI and reduce associated patient harm, such as use of chlorhexidine gluconate (CHG) bathing, the adoption of these interventions in practice is poor. The primary objective of this study was to assess the effect of a tailored, multifaceted implementation program on nursing staff’s compliance with the CHG bathing process and electronic health record (EHR) documentation in critically ill patients. The secondary objectives were to examine the (1) moderating effect of unit characteristics and cultural context, (2) intervention effect on nursing staff’s knowledge and perceptions of CHG bathing, and (3) intervention effect on CLABSI rates. Methods A stepped wedged cluster-randomized design was used with units clustered into 4 sequences; each sequence consecutively began the intervention over the course of 4 months. The Grol and Wensing Model of Implementation helped guide selection of the implementation strategies, which included educational outreach visits and audit and feedback. Compliance with the appropriate CHG bathing process and daily CHG bathing documentation were assessed. Outcomes were assessed 12 months after the intervention to assess for sustainability. Results Among the 14 clinical units participating, 8 were in a university hospital setting and 6 were in community hospital settings. CHG bathing process compliance and nursing staff’s knowledge and perceptions of CHG bathing significantly improved after the intervention (p = .009, p = .002, and p = .01, respectively). CHG bathing documentation compliance and CLABSI rates did not significantly improve; however, there was a clinically significant 27.4% decrease in CLABSI rates. Conclusions Using educational outreach visits and audit and feedback implementation strategies can improve adoption of evidence-based CHG bathing practices. Trial registration ClinicalTrials.gov, NCT03898115, Registered 28 March 2019.

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“…5 Additionally, the almost inevitable introduction of whole-genome sequencing and machine learning in healthcare epidemiology will add a large amount of data that will be best understood if presented using data visualization. [20][21][22][23] As healthcare epidemiologists, we will need to become better acquainted with phylogenetic analysis, neighbor-joining trees, and single-nucleotide polymorphism matrices. Mathematical modeling and computational epidemiology are also expanding into healthcare epidemiology.…”

Section: The Future Of Visualization In Healthcare Epidemiologymentioning

confidence: 99%

“…Mathematical modeling and computational epidemiology are also expanding into healthcare epidemiology. Examples include the use of Markov chain models to estimate the effects of HAI prevention efforts, such as chlorhexidine bathing 20 ; assessment of patient and healthcare worker mobility within institutions 24 ; and pattern recognition using cell phones, wearables, and scraping social media data. 25 The complexity of data in these disciplines can be translated into graphics for easier understanding.…”

Section: The Future Of Visualization In Healthcare Epidemiologymentioning

confidence: 99%

A primer on data visualization in infection prevention and antimicrobial stewardship

Salinas

Kritzman

Kobayashi

et al. 2020

Infect. Control Hosp. Epidemiol.

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Data visualization refers to the techniques used to communicate information by encoding it as visual objects (eg, points, lines, or bars) contained in graphics. The recent acceleration in informatics technology has made it possible to obtain and process large amounts of data. Although data visualization can provide insights from large datasets, it can also help simplify messaging, making information more accessible for healthcare stakeholders. The field of data visualization is constantly evolving, and new techniques are frequently being created. However, evidence regarding the best way to visualize data in the fields of infection prevention and antimicrobial stewardship is limited. We provide an overview of data visualization theory and history, as well as recommendations for creating graphs for infection prevention and antimicrobial stewardship.

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You get back what you give: Decreased hospital infections with improvement in CHG bathing, a mathematical modeling and cost analysis

Cited by 18 publications

References 12 publications

Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study

Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study

Results of the CHlorhexidine Gluconate Bathing implementation intervention to improve evidence-based nursing practices for prevention of central line associated bloodstream infections Study (CHanGing BathS): a stepped wedge cluster randomized trial

A primer on data visualization in infection prevention and antimicrobial stewardship

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