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Impact of measurement and feedback on chlorhexidine gluconate bathing among intensive care unit patients: A multicenter study

Published online by Cambridge University Press:  13 September 2023

Yoona Rhee
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Mary K. Hayden
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Michael Schoeny
Affiliation:
Department of Community, Systems, and Mental Health Nursing, College of Nursing, Rush University Medical Center, Chicago, Illinois
Arthur W. Baker
Affiliation:
Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
Meghan A. Baker
Affiliation:
Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Shruti Gohil
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
Chanu Rhee
Affiliation:
Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Naasha J. Talati
Affiliation:
Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
David K. Warren
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Sharon Welbel
Affiliation:
Division of Infectious Diseases, Cook County Health, Chicago, Illinois
Karen Lolans
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Bardia Bahadori
Affiliation:
Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California
Pamela B. Bell
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Heilen Bravo
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Thelma Dangana
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Christine Fukuda
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Tracey Habrock Bach
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri
Alicia Nelson
Affiliation:
Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
Andrew T. Simms
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Pam Tolomeo
Affiliation:
Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania
Robert Wolf
Affiliation:
Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
Rachel Yelin
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
Michael Y. Lin*
Affiliation:
Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois
*
Corresponding author: Michael Y. Lin; Email: Michael_lin@rush.edu

Abstract

Objective:

To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs).

Design:

A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods).

Setting:

The study was conducted across 7 geographically diverse ICUs with routine CHG bathing.

Participants:

Adult patients in the medical ICU.

Methods:

CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations.

Results:

We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions (P < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions (P < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline (P < .001).

Conclusions:

Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.

Type
Original Article
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. These data were presented in part at the SHEA Spring 2019 Conference on April 25, 2019, in Boston, Massachusetts and at IDWeek 2019 on October 3, 2019 in Washington, DC.

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