Creating an evidence-based best practice should involve three things: assessing multiple studies and research on the topic, using expertise, and considering patient preferences, according to Ann Meyer, BSN, RN.
Ms. Meyer, who is the clinical manager of antiseptics at Mölnlycke Health Care, discussed these three critical actions during a July webinar hosted by Becker's Healthcare to help establish best practices for bathing with chlorhexidine gluconate, or CHG.
CHG is a molecule that has the unique ability to bind to the proteins present in human tissues such as skin and mucous membranes. It also acts as a broad-spectrum antiseptic agent that kills a wide variety of pathogens and has a 24 hour residual activity. It was discovered in the 1950s in the United Kingdom and was introduced to the United States for use in healthcare in the 1970s.
"It's not easy being a healthcare provider today. One of our biggest challenges [is] infections," Ms. Meyer said. Infections are both deadly and costly. The annual cost nationally for the five major hospital-acquired infections — surgical site infections, ventilator-associated pneumonia, central line-associated bloodstream infections, Clostridium difficile infections and catheter-associated urinary tract infections — is approximately $9.8 billion, she said.
Bathing with CHG has been studied for years as a way to reduce said infections. Ms. Meyer analyzed several such studies to help determine if CHG bathing should be a best practice to keep patients safe.
Bloodstream infections
Cook County Hospital in Chicago performed a 52-week-long crossover study in its 22-bed medical intensive care unit to identify the most effective method to decrease bloodstream infections. The hospital compared soap and water bathing to CHG bathing, and at the end of the study, the researchers found a 61 percent decrease in bloodstream infections associated with CHG bathing.
CAUTIs
Yale-New Haven Hospital in Connecticut implemented a bundle to prevent CAUTIs, which included bathing all patients in the MICU with 4 percent CHG. At the end of the year-long study, CAUTIs decreased from nine to zero at that hospital.
VAPs and CAUTIs
"It was a little challenging trying to find a study having to do with CHG bathing and VAPs," Ms Meyer said, but she found one study in Mexico that evaluated CHG bathing and hand hygiene compliance at a 450-bed hospital.
The combined measure of routine daily CHG bathing of every patient and enhanced hand hygiene compliance reduced the rates of VAP and CAUTIs at the hospital, likely because of a reduction in the environmental load of bacteria.
SSIs
Previously, SSIs were often blamed on operating room staff, Ms. Meyer said. "But we don't have that luxury anymore, because there's a growing body of evidence that suggests these SSIs are being acquired postoperatively ... everyone has to assume responsibility."
To fight SSIs, Rochester, Minn.-based Mayo Clinic implemented a bundle for colorectal surgery involving patients bathing with a 4 percent CHG cleanser prior to surgery, nurses wiping the patient prior to surgery with a CHG wipe if they hadn't bathed with CHG and the use of alcohol and CHG in the OR. Postoperatively, CHG use was continued, including discharging the patient with a 4-ounce bottle of soap-based CHG and instructing them to use it to clean the wound while bathing until the bottle was empty.
The study showed a significant reduction in SSIs: from 9.8 to 4 percent overall and 4.9 to 1.5 percent in superficial SSIs.
Methicillin-resistant Staphylococcus aureus
A study conducted in 43 Hospital Corporation of America hospitals compared the effectiveness of MRSA screening and isolation, targeted MRSA decolonization and universal decolonization using a CHG product.
Researchers found universal decolonization with a CHG product was more effective than the other modes in reducing rates of MRSA, likely because of the decreased risk in cross contamination.
Carbapenem-resistant Acinetobater baumannii
CRAB "is a new nightmare bacteria," Ms. Meyer said, as it is highly resistant to most antibiotics. One study found that after a 12-month period in which patients were bathed daily with CHG in a hospital in Korea, there was a 51.8 percent reduction of CRAB acquisition rates, likely because of environmental decontamination.
C. diff
While CHG does not kill a spore of C. diff, it can kill the bacteria in its vegetative state.
In a 19-month study at a 689-bed hospital, all patients were bathed daily with 4 percent CHG with a high rate (90 percent) of adherence. The hospital saw a 70 percent decline in C. diff infections. Additionally, the incidence of C. diff infections increased after the CHG bathing stopped.
"Compliance equals results," Ms. Meyer said.
Results
"There's no one thing that's going to cure everything," she said. "We've seen a lot of bundles, and CHG bathing is the base of all the bundles. But then each specific infection is going to have to have a few more elements to the bundle for it to be successful."
The studies examined in the webinar provide reliable evidence that CHG has a positive effect on infection rates when implemented correctly and when staff are educated on compliance. Additionally, many studies also noted that CHG bathing does not have a negative effect on patients' skin quality, which supports the patient experience.
"[CHG] is the skin decolonization agent that has the strongest evidence base," Ms. Meyer concluded. "It's also a great horizontal strategy that goes across many bundles. It's the base and then you build on it."
Click here to see a recording of the webinar on YouTube, and click here to download the slide deck.