Nurses were more likely to comply with protocols for the daily bathing of ICU patients when they could use chlorhexidine gluconate (CHG) wipes rather than CHG solution.
HOUSTON—Hospitals may be able to decrease ICU infections by bathing patients with chlorhexidine gluconate (CHG) wipes, rather than CHG solution, according to Ranekka Dean, MPA, RN, from NYU Langone Medical Center, New York City, and colleagues. Their findings were presented at the Society of Critical Care Medicine’s 41st Critical Care Congress.
“Nursing staff preferred CHG wipes over the CHG solution, which was substantiated by greater compliance” with ICU bathing protocols, the researchers said. They added that during their 24-week study, which required nurses in four ICUs to use CHG wipes for 12 weeks and CHG solution for another 12 weeks, the rate of central line-associated bloodstream infections (CLABSIs) decreased by 50%.
The study compared a daily protocol that required nurses to bathe patients using 2% CHG solution with a protocol that included the use of six 2% CHG-impregnated cloths. For the latter protocol, nurses used one cloth each to clean the following portions of a patient’s body:
• neck, chest, both arms, and underarms
• abdomen and groin
• right leg and foot
• left leg and foot
• the back
• buttocks, including the skin fold
The study included two cohorts, the first consisting of an 18-bed medical ICU and a 12-bed pediatric ICU and the second consisting of a 17-bed surgical ICU and a five-bed cardiovascular surgical care unit. During the study’s first half, nurses in each cohort were randomly assigned to one of the protocols. The protocols were crossed over during the second half to control for confounders.
At four points during the study period, nurses were surveyed about their preferences and views on ease of use and effectiveness with regard to the two protocols. The surveys were anonymous Likert scale questionnaires in which answers of 1 meant “strongly agree” and answers of 5 meant “strongly disagree.” The researchers determined CLABSI rates before and during the study period, and they assessed compliance with and costs of the protocols by reviewing the ICUs’ consumption of materials.
Fewer Infections, Greater Compliance
In the six months before the study, the ICUs had a CLABSI rate of 3.1 per 1,000 central venous catheter (CVC) days. That rate dropped to 1.5 per 1,000 CVC days during the study period.
The 206 survey respondents indicated that they preferred the CHG wipes and perceived them as easier to use and more effective than the CHG solution. When each method was assessed after three months of use, the cloth protocol and the solution protocol garnered median Likert scores of 1.1 versus 1.6, respectively, on questions about whether each method was followed; 2.3 versus 1.7 on questions about whether the amount supplied was adequate for bathing; 1.9 versus 2.4 on questions about their perceived effectiveness; 1.8 versus 2.4 on questions about their ease of use; 1.4 versus 2.1 on questions about their convenience; and 1.9 versus 2.6 on questions about whether they improved patient bathing.
The review of material consumption revealed a mean rate of 89% compliance for the CHG wipe protocol (range, 40% to 100%), compared with a mean rate of 36% compliance for the solution protocol (range, 16% to 42%). However, the wipes also proved more expensive than the solution, with material costs of $19,734 and $7,013, respectively.
“Identifying and adopting the method of applying CHG with highest preference among nursing staff may increase compliance and therefore minimize risk of infection in ICU patients,” the researchers concluded.
Dixon JM, Carver RL. Daily chlorhexidine gluconate bathing with impregnated cloths results in statistically significant reduction in central line-associated bloodstream infections. Am J Infect Control. 2010;38(10):817-821.