Reduction of BSIs and resistant organism infections: Success with Chlorhexidine Gluconate Daily Baths in ICUs

Purpose:
The average cost for a BSI is $40,000/patient; many are preventable. The ultimate goal of the project was to save lives in our hospital by preventing blood stream infections and resistant organisms by using chlorhexidine gluconate wipes for daily bathing instead of traditional procedures.

Significance:
The goal was to reduce BSIs by using chg wipes for daily baths. 80,000 patients in ICUs develop CLBSIs annually in the U.S. The average cost for these infections is $40,000/patient. Many are preventable and this is a key focus area of quality and safety initiatives around the country.

Strategy and Implementation:
The innovation was daily bathing with use of CHG wipes in our CV and MICU's to decrease BSIs. A flowchart was created to identify variables in delivering baths. A procedure for using CHG wipes was developed, challenges and contraindications for use identified, continuous availability of supplies ensured, and information disseminated to all staff. Educational sessions included an introduction to the CHG wipes, review of the new procedure,potential benefits to patients, details about proper use and monitoring of the warmer for the CHG wipes and the process for charging and restocking the wipes. A patient education flyer with an overview of the purpose of the wipes and the benefits to using them for bathing was created to ensure understanding of the change. A standard method for documentation was written and shared with staff. Monitoring of the process change began soon after implementation. A data collection tool was designed to monitor compliance and has been and is successfully used.

Evaluation:
Rates of BSIs from VRE and MRSA were measured for 6 months prior to and after the CHG baths were implemented. The BSI rates decreased from the 6 months prior to implementation of the baths from 1.6 to 0.73 in the CVICUs and from 4.39 to 0.83 in one MICU and 2.35 to 0.78 in the second MICU.

Implications for Practice:
Daily bathing using CHG wipes has resulted in improved MRSA,VRE and BSI rates. Other outcomes include improved staff efficiency for bathing patients, patient/family appreciation of staff efforts to reduce hospital acquired infections and engagement of the bedside clinician in process improvement.