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CHG Bathing (CLOTHS or FOAM) will be used on all patients to help prevent Healthcare Associated Infections (HAIs) Kim Delahanty , BSN,PHN,MBA/HCM Administrative Director IPCE/TB Control. House wide CHG Bathing Proposal . Situation . Current Use of CHG for daily bathing.

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house wide chg bathing proposal

CHG Bathing (CLOTHS or FOAM) will be used on all patients to help prevent Healthcare Associated Infections (HAIs)

Kim Delahanty, BSN,PHN,MBA/HCM

Administrative Director IPCE/TB Control

House wide CHG Bathing Proposal

situation
Situation

Current Use of CHG for daily bathing

Endorsements to expand use

IPCE & Infection Control Committee

Nursing Cabinet

Clinical Practice Council

Skin Committee

Nurse exec

Patient Safety Committee

Peri-Op Committee

Quality Council

  • Daily CHG bathing implemented for all ICU patients as part of CLABSI and VAP bundles began in 2009
  • Partial implementation of daily CHG bathing for surgical patients in 2011
  • Trial of daily CHG bathing in Bone and Marrow Transplant Unit in 2012
background
Background
  • Literature review – has historically focused on ICU, but compelling enough to want to transfer outcomes to other areas if possible. Hard to determine one source of improvement when items are included in ‘bundles’
    • “effective horizontal infection prevention intervention that can have an impact on a variety of HAIs” – Rupp, et al (2012).
    • 7727 patients enrolled. 28% lower CLABSI rate with CHG bathing. Climo, et al (2013). NEJM.
  • Endorsed by CDC Guidelines 2011
recommendation who is d aily chg bathing recommended for
Recommendation: Who is daily CHG bathing recommended for?

Daily bathing with CHG foam

Daily bathing CHG cloths

All ICU patients

Bed bound patients

Non ambulating patients

  • Ambulatory patients
  • Ambulating post Op C-section patients
    • Specific protocol
recommendation 2 products to be used depending on staff and patient preference mobility
Recommendation: 2 Products to be used – Depending on staff and patient preference / mobility

2% CHG Cloths from Sage

4% CHG Foam from Hibiclens

One 16 oz. foam bottle is $5.91

Cost per application would be $0.75 assuming 2 oz is used.

  • One Bath package is $5.52
    • Package includes 6 cloths for total body coverage
plan for implementation
Plan for Implementation
  • Education for RNs and CCPs required for safe practice, as per current guidelines and recommendations
  • Proper disposal must be ensured
  • Signage and patient/family education required
  • Delivery of warmer units, as required
  • Documentation of daily CHG bath in EPIC(revision needed)
  • Ongoing IPCE data; possible impact on CAUTI/SSI
select references in and outside the icu
Select References: In and outside the ICU
  • New England Journal of Medicine article (362;1 nejm.org January 7, 2010) showed 41-45% reduction in SSI and CLABSI
  • SHEA Decennial HAI reduction was shown to be 20-40% using CHG for daily bathing
  • Increasing interest and implementation outside of ICU in literature and community:
    • UCI – daily bathing of all patients
    • UCSF – daily bathing of all ICU and PICU patients
    • UCD and UCLA – pre-op bathing
hicpac guidelines for ssi prevention up for public comment
HICPAC Guidelines for SSI Prevention up for Public Comment
  • Q8A. How safe and effective is preoperative antiseptic bathing or showering?
  • The available data examined the following comparisons:
  • 1. Chlorhexidinegluconate (CHG) solution vs. placebo solution
  • 2. CHG solution vs. un-medicated bar soap
  • 3. CHG solution vs. no wash
  • 4. CHG whole body wash vs. partial body wash
  • 5. Aqueous iodophor solution vs. control (“routine personal hygiene”)
  • For all comparisons we considered SSI as the critical outcome. Product-related adverse reaction outcomes were also evaluated.
q8a 1 chg solution vs placebo solution
Q8A.1. CHG solution vs. placebo solution
  • High-quality evidence suggested no benefit of preoperative bathing or showering with 4% CHG solution as compared to placebo. This was based no difference in SSI in both a meta-analysis (N=7791) of 4 RCTs94,95,97,99,100 and a meta-analysis (N=6302) restricted to only the 2 higher quality studies.94,95,99 Each individual trial found no difference.
q8a 2 chg solution vs un medicated bar soap
Q8A.2. CHG solution vs. un-medicated bar soap
  • High-quality evidence suggested no benefit of preoperative bathing or showering with 4% CHG solution as compared to un-medicated bar soap. This was based on no difference in SSI in a meta-analysis (N=1443) of 3 RCTs. 94,96-
q8a 3 chg solution vs no wash
Q8A.3. CHG solution vs. no wash
  • Moderate-quality evidence suggested no benefit of preoperative showering with 4% CHG solution as compared to no wash. This was based on no difference in a meta-analysis (N=1142) of 3 RCTs. 94,98,100,101
q8a 4 chg whole body vs partial body wash
Q8A.4. CHG whole body vs. partial body wash
  • Moderate-quality evidence suggested a benefit of a CHG shower (i.e., a whole body wash including the scalp) as compared to a partial body wash (restricted to the proposed surgical site).
q8a 5 aqueous iodophor solution vs control routine personal hygiene
Q8A.5. Aqueous iodophor solution vs. control (“routine personal hygiene”)
  • Very low-quality evidence suggested no benefit of preoperative shower with 10% aqueous iodophor solution as compared to routine personal hygiene.
other guidelines
Other Guidelines
  • Clinical practice guidelines recommend that patients shower or bathe with an antiseptic agent or soap on at least the night before surgery.12,234 They do not favor the use of one antiseptic agent in preference of another. There may be contraindications for specific antiseptic-agent use in some patients or surgical procedures.