EMORY HEALTHCAREPage 1

Chlorhexidine Gluconate Bath and

Reduction of Hospital Associated

InfectionsEmory University Hospital

Carolyn Holder RN, MN CCRN APRN-BC

Mary Zellinger RN MN, CCRN,CSC APRN-BC

Clinical Nurse Specialists

EMORY HEALTHCAREPage 2

0.00

0.73

3.82

2.24

0.00

1.25

0.00 0.00

0.75

1.40 1.40

2.302.50

2.10 2.102.40 2.40 2.50

0.00

1.00

2.00

3.00

4.00

5.00

6.00

4A ICU 5A ICU 5E ICU 2G ICU 3G CCU 4G CCU 5G ICU 6G ICU 2D ICU

Rate

per

1000 P

t. D

ays

Central Line Associated Bloodstream Infection RatesEUH Fiscal Year 2009

FYTD Avg NHSN

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M ICU & CVICU TeamName Role Name Role

Carolyn

Holder

Clinical

Nurse

Specialist

MICU

Patti

Berdini

Ashley

Snyder

Lilly

Anickat

Amy

Hanik

Alexis

MacKenzie

Staff

Nurse,

MICUMicah

Fisher

Medical

Director,

MICU

Mary

Zellinger

Clinical

Nurse

Specialist

CVICU

Toni Ash

Caroline

Durkee

Staff

Nurse,

CVICU

Christine

Lallos

Medical

Director

CVICU

Connie

Bryant

Regina

Howard

Infection

Control

Nurse

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Aim Statement

Decrease hospital associated bloodstream infections by

using daily chlorhexidine gluconate baths in ICU

patients :

By 50%

Six months after intervention is implemented 9/2008

In all MICU and CVICU patients

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Changes Tested

Change: Staff educated on daily bath procedure using

CHG bath cloths March 2008

Appropriate warmers provided by manufacturer to

provide warm CHG cloths for patient bath

Procedure revised with products that are compatible and

those that are not compatible with CHG April 2008

Worked with Hospital Purchasing to identify skin

products that are compatible with CHG ie Lotion

Clinical rounds and huddles with staff to discuss

challenges with CHG baths, check for documentation of

CHG bath in electronic documentation

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Plan

Test of change : Institute Chlorhexidine gluconate

(CHG ) bath cloths for daily bathing in the

cardiovascular and medical ICU’s at Emory University

Hospital

Procedure developed March 2008

Staff educated March 2008

Start Date: April 1, 2008

Measure: Bloodstream infection rates from central

venous catheters and with VRE and MRSA for 6 months

prior to the study and for 6 months after the CHG baths

implemented. Compliance with daily bath random

monitors

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Chlorhexidine Bath Flow Chart

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Chlorhexidine Bath Fishbone Diagram

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CV Surgery & Medical ICU VRE/MRSA

Rates Prior to CHG Baths

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

Sep

-07

Oct

-07

No

v-0

7

Dec

-07

Jan

-08

Feb

-08

Mar

-08

Ap

r-08

4A/5A/5GS/6GS VRE/MRSA Rates Combined

Rate/1000 Pt Days Mean

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0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

9.00

Sep

-07

Oct

-07

No

v-0

7

Dec

-07

Jan

-08

Feb

-08

Mar

-08

Ap

r-08

May

-08

Jun

-08

Jul-

08

Aug-

08

Sep

-08

4A/5A/5GS/6GS VRE/MRSA Rates Combined

Rate/1000 Pt Days Mean Rate/1000 Pt Days

CHG bath s

CVICU & MICU VRE/MRSA Rates

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Catheter Related Associated

Blood Stream Infections After CHG Bath

0.00

1.00

2.00

3.00

4.00

5.00

6.00

7.00

8.00

Months

4A/5A/5G/6G ICU CLABSI Rates

Rates

Mean

Upper Control Limit

Staff

huddles

Procedure

developed

group effort

CHG daily

baths in ICU

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Keys to Success & Lessons Learned

Compatibility issues with chlorhexidine were extremely

challenging for staff and all involved

Staff nurse & Tech/PCA champions are essential to

changing a basic procedure ie. Daily bathing

Sharing data with staff re: costs of bloodstream

infections, potential bad outcomes for patient re: LOS

and mortality rate extremely helpful for staff buy in and

with staff engagement

CMS changes in October 2008 re: non payment for

hospital acquired infections was important to share with

staff

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Daily Bathing with an Antiseptic

In an effort to reduce a

chance for infection we

will be bathing your loved

one daily with

chlorhexidine which helps

to provide a barrier to

bacteria. Evidence shows

that this is more effective

than soap and water!

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Incompatible Products

Any other brand name lotion/bath products (ex: Bath and

Body Works, Suave, etc)

Dial Soap

All deodorants

Tap Water

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Compatible Products

Proshield Ointment

Xenaderm

Comfort Shield Incontinence Wipes & White Baths

Keri Lotion

Aquaphor Original Formula Ointment

Lubriderm Dry Skin Care Lotion

Eucerin Original Lotion

Vaseline 100% Pure Petroleum Jelly

Alcohol foams or rubs

Keri Oil

Sween 24 cream

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Next Steps

We are monitoring compliance with the CHG daily

baths by reviewing 30 charts per month to check for

documentation of CHG bath. Goal is 90% compliance

with daily CHG bath.

ICUs will implement patient education for those who are

awake and able to do self bath to encourage them to use

CHG for bath.

Expand use of CHG baths at EUH and EUHM:

Develop a research proposal to evaluate the effectiveness

of using CHG daily baths on BSI rates for general units.