Fran Lowry

July 03, 2015

Central-line-associated bloodstream infections were reduced by 59% in a large pediatric hospital when children were bathed daily with disposable cloths containing 2% chlorhexidine gluconate. In just 6 months, this saved the hospital approximately $300,000.

"Great success in reducing hospital-acquired infections with chlorhexidine bathing" has been reported in previous studies, said Adam Karcz, MPH, from the Riley Hospital for Children at Indiana University Health in Indianapolis.

"As infection preventionists, our goal is to find ways to prevent infections in our patients," he told Medscape Medical News.

At his hospital, chlorhexidine bathing had reduced bloodstream infections in hematology and oncology units. After discussions and a literature review, "we decided to develop a house-wide implementation of the practice" to reduce hospital-acquired infections, Karcz said at the Association for Professionals in Infection Control and Epidemiology 2015 Annual Meeting in Nashville, Tennessee.

"Chlorhexidine gluconate is a chemical compound that has been in use for many years. It is used in oral rinses, needleless connectors, catheters, skin preparation for surgery, and patient bathing — all to prevent infection. Chlorhexidine gluconate works by breaking the cell membrane of pathogens, effectively destroying them," he explained.

Karcz and his team worked with nursing staff, parents, and hospital leaders to develop a comprehensive educational program to adopt daily chlorhexidine bathing for all patients and to strengthen adherence to a bundle of prevention practices already in place for patients with central lines.

In addition to daily bathing with chlorhexidine-impregnated wipes, linens were changed every day, central-line dressings were assessed, and regular tubing and caps were changed on the lines. The technique for giving medications was also assessed.

During the implementation, Karcz and his team discussed barriers to performing chlorhexidine bathing and worked with families and healthcare staff to ensure full adoption of the program.

"One of the barriers to implementation of daily bathing with chlorhexidine wipes is that the product tends to feel sticky for a few minutes after application. Another is that some patients and parents prefer a shower or a bath," Karcz explained. Because it "is a product that is new to parents and families," there was some hesitance.

Some patients were not able to use the chlorhexidine wipes, such as those with a chlorhexidine allergy, infants in the neonatal intensive care unit who were younger than 40 weeks' adjusted gestational age, patients who were admitted to the hospital for observation, those with cystic fibrosis, those receiving certain chemotherapy drugs, those with open wounds, and those third- and fourth-degree burns.

"We took great care to ensure the successful implementation of the bathing regimen," Karcz reported. "Our executive suite and unit managers made sure all staff understood that this was a priority. By educating everyone on the care team, including parents, and standardizing bathing procedures, we were able to dramatically reduce infections and save healthcare dollars in just 6 months."

Bathing compliance increased from 45% to 81% during the 6-month study period. In the 6 months before the program was implemented, there were 22 central-line-associated bloodstream infections in the 269-bed hospital. With the program, that number dropped to nine.

There was also a 56% drop in the number of methicillin-resistant Staphylococcus aureus infections in the hospital during the study period.

In addition, the bathing program saved money. "The 59% reduction in healthcare-associated infections during the implementation period represents a potential cost savings of $297,999," Karcz reported.

Education and Implementation

The success of the daily bathing study lies in the implementation. "Before this study began, we spent a great deal of time discussing, planning, and evaluating the best method to implement this program at the highest level, with the focus on reducing hospital-acquired infections," he explained.

"Our hematology and oncology units had implemented chlorhexidine bathing previously and were crucial in assisting us in developing our bathing protocol, talking points, and frequently asked questions," Karcz said. "We utilized our hospital administration, physicians, nurses, patient care assistants, clinical nurse specialists, nurse educators, supply chain, and other departments to develop this."

Cynthia Kohan, MS, from the Waterbury Hospital in Connecticut explained that "a central-line-associated bloodstream infection for any patient is a serious event, but for pediatric patients and their families, it is particularly traumatic."

"What stood out for me about this study is the careful attention given to educating and informing each member of the care team, as well as the patients' families, about the new intervention," Kohan told Medscape Medical News. "Meticulous attention was given to each step of the care and maintenance of the central catheter."

Mr Karcz and Ms Kohan have disclosed no relevant financial relationships.

Association for Professionals in Infection Control and Epidemiology (APIC) 2015 Annual Meeting: Abstract 81243. Presented June 26, 2015.

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