chlorhexidine gluconate bath and reduction of hospital
TRANSCRIPT
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
EMORY HEALTHCAREPage 3
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
EMORY HEALTHCAREPage 4
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
EMORY HEALTHCAREPage 5
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
EMORY HEALTHCAREPage 6
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
EMORY HEALTHCAREPage 7
Chlorhexidine Bath Flow Chart
EMORY HEALTHCAREPage 8
Chlorhexidine Bath Fishbone Diagram
EMORY HEALTHCAREPage 9
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
EMORY HEALTHCAREPage 10
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
EMORY HEALTHCAREPage 11
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
EMORY HEALTHCAREPage 12
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
EMORY HEALTHCAREPage 13
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!
EMORY HEALTHCAREPage 14
Incompatible Products
Any other brand name lotion/bath products (ex: Bath and
Body Works, Suave, etc)
Dial Soap
All deodorants
Tap Water
EMORY HEALTHCAREPage 15
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
EMORY HEALTHCAREPage 16
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.