Bathing hospitalized dependent patients with prepackaged disposable washcloths instead of traditional bath basins

Martin, E.T. et al. American Journal of Infection Control | Published online: 11 May 2017

hands-2238235_960_720.jpg

Highlights: 

  • Basins used for patient bathing may become contaminated with resistant organisms.
  • Disposal washcloths had no effect on prevention of infection in a randomized trial.
  • Skin deterioration was less among patients bathed by disposable washcloth.

Read the full abstract here

Hospital-wide chlorhexidine gluconate bed bathing protocol

Reese, S.M. et al. American Journal of Infection Control. Published online: 5 January 2017

The objective of this study was to determine understanding of bed bathing practices over time after the implementation of a standardized bed bathing protocol. An online survey addressing bathing practices was administered preintervention and 6 and 18 months postintervention to all nurses and technicians caring for adult patients. Survey responses suggested that the intervention resulted in sustained understanding of the standardized bed bathing protocol.

Read the abstract here

Reduction in hospital-associated MRSA with daily chlorhexidine gluconate bathing for medical inpatients

Lowe, C.F. et al. American Journal of Infection Control. Published online 8 December 2016

N0025608 TEM of vancomycin resistant enterococcus faecalis

Image source: J L Carson – Wellcome Images // CC BY-NC-ND 4.0

Image shows transmission electron microscopy of vancomycin resistant enterococcus faecalis.

Background: Daily bathing with chlorhexidine gluconate (CHG) is increasingly used in intensive care units to prevent hospital-associated infections, but limited evidence exists for noncritical care settings.

Conclusions: This prospective pragmatic study to assess daily bathing for CHG on inpatient medical units was effective in reducing hospital-associated MRSA and VRE. A critical component of CHG bathing on medical units is sustained and appropriate application, which can be a challenge to accurately assess and needs to be considered before systematic implementation.

Read the full abstract here

Chlorhexidine bathing and health care-associated infections among adult intensive care patients

Frost, S.A. et al. Critical Care. Published online: 23 November 2016

 

L0075034 An intensive care unit in a hospital.

Image source: Robert Priseman – Wellcome Images // CC BY-NC-ND 4.0

Background: Health care-associated infections (HAI) have been shown to increase length of stay, the cost of care, and rates of hospital deaths . Importantly, infections acquired during a hospital stay have been shown to be preventable. In particular, due to more invasive procedures, mechanical ventilation, and critical illness, patients cared for in the intensive care unit (ICU) are at greater risk of HAI and associated poor outcomes.

Conclusion: This meta-analysis of the effectiveness of CHG bathing to reduce infections among adults in the ICU has found evidence for the benefit of daily bathing with CHG to reduce CLABSI and MRSA infections. However, the effectiveness may be dependent on the underlying baseline risk of these events among the given ICU population. Therefore, CHG bathing appears to be of the most clinical benefit when infection rates are high for a given ICU population.

Read the full abstract and article here

Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU

Swan, J.T. et al. (2016) Critical Care Medicine. 44(10) pp. 1822–1832

rubber-duck-1390639_960_720Objective: To test the hypothesis that compared with daily soap and water bathing, 2% chlorhexidine gluconate bathing every other day for up to 28 days decreases the risk of hospital-acquired catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection in surgical ICU patients.

Design: This was a single-center, pragmatic, randomized trial. Patients and clinicians were aware of treatment-group assignment; investigators who determined outcomes were blinded.

Setting: Twenty-four–bed surgical ICU at a quaternary academic medical center.

Patients: Adults admitted to the surgical ICU from July 2012 to May 2013 with an anticipated surgical ICU stay for 48 hours or more were included.

Interventions: Patients were randomized to bathing with 2% chlorhexidine every other day alternating with soap and water every other day (treatment arm) or to bathing with soap and water daily (control arm).

Measurements and Main Results: The primary endpoint was a composite outcome of catheter-associated urinary tract infection, ventilator-associated pneumonia, incisional surgical site infection, and primary bloodstream infection. Of 350 patients randomized, 24 were excluded due to prior enrollment in this trial and one withdrew consent. Therefore, 325 were analyzed (164 soap and water versus 161 chlorhexidine). Patients acquired 53 infections. Compared with soap and water bathing, chlorhexidine bathing every other day decreased the risk of acquiring infections (hazard ratio = 0.555; 95% CI, 0.309–0.997; p = 0.049). For patients bathed with soap and water versus chlorhexidine, counts of incident hospital-acquired infections were 14 versus 7 for catheter-associated urinary tract infection, 13 versus 8 for ventilator-associated pneumonia, 6 versus 3 for incisional surgical site infections, and 2 versus 0 for primary bloodstream infection; the effect was consistent across all infections. The absolute risk reduction for acquiring a hospital-acquired infection was 9.0% (95% CI, 1.5–16.4%; p = 0.019). Incidences of adverse skin occurrences were similar (18.9% soap and water vs 18.6% chlorhexidine; p = 0.95).

Conclusions: Compared with soap and water, chlorhexidine bathing every other day decreased the risk of acquiring infections by 44.5% in surgical ICU patients.