Preventing Hospital-Acquired

Infections
with Chlorhexidine Bathing

Mike Cook
Garrett Mongelluzzo
Dallas Hafner
Haralambos Vavlas
University of South Florida
College of Nursing

Proposed Change
Implement daily chlorhexidine (CHG) bathing
protocol in the following patient populations and
hospital floors
All intensive care unit (ICU) patients
All non-ICU patients with central-lines

Importance to Healthcare
722,000 hospital-acquired infections (HAI) & 75,000 deaths in U.S. Hospitals (Centers
for Disease Control and Prevention [CDC], 2016)
Infection and sepsis = leading cause of death in non-cardiac ICUs (Vincent et al.,
2009)
Mortality rates reaching as high as 60% for infection and sepsis (Vincent et al., 2009)
50% of HAIs are preventable (Zimlichman et al., 2013)
Patient stay doubles with a HAI (McCall, 2012)
Healthcare associated infections are associated with substantial healthcare costs not
reimbursed by third party payers (Vincent et al., 2009)
CHG has broad-spectrum activity against many organisms (McCall, 2012)

Supportive Literature
Climo et al. (2013)
Reduction in the multidrug resistant organisms (MDRO) acquisition rate by 23%
(p=.03)
Reduction in central-catheter-associated bloodstream infections by 53% (p=.004)
Reduction in HABSI by 28% (p=.007)
Huang et al. (2013)
Universal decolonization reduced MRSA-positive
clinical cultures by 37% (p=.01)
Milstone et al. (2013)
CHG bathing lowered the risk of bacteremia in critically ill
children by 36% (p=.044)
Climo et al. (2013)

Plan
Objectives: Reduce number of hospital-acquired
infections in both ICU and non-ICU patients
Prediction: HAI reduction of 25% or greater on floor
Plan to Carry Out Successful Intervention

Who: Nurses and PCTs

What: Use of 2% CHG cloths
Where: Both ICU and non-ICU units
When: 1x daily bathing of patients fitting criteria

Data Collection

Comparison of pre and post HAI data for each floor unit

Opportunities & Challenges

Opportunities
To improve patient outcomes and quality of care
To improve efficiency for hospitals and reduce costs
To improve efficiencies for the U.S. healthcare system
Challenges
Adherence to new intervention
Ensuring effective bathing techniques
Future Use
Combine with new EBP techniques for reducing HAIs
Report results and provide sharing of data to other floors & organizations

Do
Education to nurses regarding procedure
Intervention team champion
Motivates staff on importance
Monitors intervention is performed is a core measure
(CDC, 2009)
Documents observations and strengths and weaknesses
of plan
Updates staff weekly

Recording Data
Number of hospital-acquired infections after 48 hours of
hospital stay

Study
After six months of implementation of daily
chlorhexidine bathing protocol:
Analyze differential rates of:
Hospital-acquired bloodstream infections
Central catheter-associated blood-stream infections
Multidrug resistant organism acquisitions (MRSA, VRE, MDRO)

Evaluate differential hospital stay durations

Evaluate data in progress for potentially

marked increases in negative outcomes
To ensure patient safety

Act
Evaluate the efficacy of CHG bathing protocol on
hospital-acquired infections.
If reduction in HAIs and patient length of stay, the
improvement should become the standard of care.
If predictive outcomes are not met, team will return
to stage 1 and devise a different plan to reduce HAIs.
Constant evaluation is required in order to further
improve patient outcomes.

References
Centers for Disease Control and Prevention. (2009). Central line-associated bloodstream infections (CLABSI)
in non-intensive care unit (non-icu) settings toolkit. Retrieved from
http://www.cdc.gov/HAI/pdfs/toolkits/CLABSItoolkit_white020910_final.pdf
Climo, M. W., Yokoe, D.S., Warren, D.K., Perl, T.M., Bolon, M., Herwaldt, L.A., Wong, E.S. (2013). Effect of
daily chlorhexidine bathing on hospital-acquired infection.The New England Journal of Medicine, 368(6),533542. doi:10.1056/NEJMoa1113849
Huang, S.S., Septimus, E., Kleinman, K., Moody, J., Hickok, J., Avery, T., Platt, R. (2013). Targeted versus
universal decolonization to prevent icu infection. The New England Journal of Medicine, 368(24), 2255-2265.
doi:10.1056/NEJMoa1207290
Milstone, A. M., Elward, A., Song, X., Zerr, D. M., Orscheln, R., Speck, K., Perl, T. M. (2013). Daily
chlorhexidine bathing to reduce bacteremia in critically ill children: A multicenter, cluster-randomized, twoperiod crossover trial.The Lancet,381(9872), 10991106. doi:10.1016/S0140-6736(12)61687-0
Zimlichman, E., Henderson, D., Tamir, O., Franz, C., Song, P., Yamin, C.K.Bates, D. (2013). Health careassociated infections; A meta-analysis of costs and financial impact on the US health-care system. JAMA
Internal Medicine, 173(22), 2039-2046.