Chlorhexidine Gluconate Bath and Reduction of Hospital Associated Infections
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1 Chlorhexidine Gluconate Bath and Reduction of Hospital Associated Infections Emory University Hospital Carolyn Holder RN, MN CCRN APRN-BC Mary Zellinger RN MN, CCRN,CSC APRN-BC Clinical Nurse Specialists Page 1
2 Rate per 1000 Pt. Days Central Line Associated Bloodstream Infection Rates EUH Fiscal Year A ICU 5A ICU 5E ICU 2G ICU 3G CCU 4G CCU 5G ICU 6G ICU 2D ICU FYTD Avg NHSN Page 2
3 Name Role Name Role M ICU & CVICU Team Carolyn Holder Micah Fisher Clinical Nurse Specialist MICU Medical Director, MICU Patti Berdini Ashley Snyder Lilly Anickat Amy Hanik Alexis MacKenzie Staff Nurse, 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 Page 3
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 Page 4
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 Page 5
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 Page 6
7 Chlorhexidine Bath Flow Chart Page 7
8 Chlorhexidine Bath Fishbone Diagram Page 8
9 CV Surgery & Medical ICU VRE/MRSA Rates Prior to CHG Baths Sep-07 Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr A/5A/5GS/6GS VRE/MRSA Rates Combined Rate/1000 Pt Days Mean Page 9
10 Sep-07 CVICU & MICU VRE/MRSA Rates Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep A/5A/5GS/6GS VRE/MRSA Rates Combined CHG bath s Rate/1000 Pt Days Mean Rate/1000 Pt Days Page 10
11 Catheter Related Associated Blood Stream Infections After CHG Bath 4A/5A/5G/6G ICU CLABSI Rates Procedure developed group effort Staff huddles CHG daily baths in ICU Rates 4.00 Mean Upper Control Limit Months Page 11
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 Page 12
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! Page 13
14 Incompatible Products Any other brand name lotion/bath products (ex: Bath and Body Works, Suave, etc) Dial Soap All deodorants Tap Water Page 14
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 Page 15
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. Page 16
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