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.

Improving Infection Prevention and Control Practices Using Participatory Visual Methods

The purpose of this quality improvement project was to determine the feasibility of using provider-led participatory visual methods to scrutinize 4 hospital units’ infection prevention and control practices.

Methods included provider-led photo walkabouts, photo elicitation sessions, and post-improvement photo walkabouts. Nurses readily engaged in using the methods to examine and improve their units’ practices and reorganize their work environment.

Full reference:  Backman C, Bruce N, Marck P, Vanderloo S. Engaging Direct Care Providers in Improving Infection Prevention and Control Practices Using Participatory Visual Methods. J Nurs Care Qual. 2015 Dec 16. [Epub ahead of print]

Reducing health care-associated Clostridium difficile infection.

Clostridium difficile is the most frequent cause of health care–associated diarrhea and is a significant cause of morbidity and mortality.

A multidisciplinary task force, with the goal of reduction of Clostridium difficile infection (CDI) rates was formed; they instituted multiple, comprehensive interventions, including education of health care providers, proper environmental cleaning of rooms with CDI patients, and reduction in the use of fluoroquinolones.

These interventions were successful in reducing rates of health care–associated Clostridium difficile infection in the hospital.

Full reference: Waqar, S et al. Multidisciplinary performance improvement team for reducing health care–associated Clostridium difficile infection. American Journal of Infection Control 2015 Nov 3 [Epub ahead of print]

 

Infection prevention and control: lessons from acute care in England

Latest Health News

November 2015 | The Health Foundation

Infection control has been high on the political agenda and on the agenda of the NHS in England in recent years. There have been many successes, not least the reduction in MRSA bloodstream infections and cases of Clostridium difficile infection. However, other health care associated infections that have not been monitored as rigorously are growing in incidence. New infections, including the growing number of more resistant strains of bacteria, are in danger of spreading. As a result, infection control needs to remain central to the work of the NHS.

This learning report is based on the findings of a large research study that identified and consolidated published evidence about infection prevention and control initiatives. The researchers synthesised this with findings from qualitative case studies in two large NHS hospitals, including the perspectives of service users.

via Infection prevention and control: lessons from acute care in England | The…

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An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial

The Lancet: Volume 386, No. 10004, p1631–1639, 24 October 2015

hand washing

Background
Handwashing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic. However, the role of handwashing is debated, and no good randomised evidence exists among adults in non-deprived settings. We aimed to assess whether an internet-delivered intervention to modify handwashing would reduce the number of RTIs among adults and their household members.

Methods
We recruited individuals sharing a household by mailed invitation through general practices in England. After consent, participants were randomised online by an automated computer-generated random number programme to receive either no access or access to a bespoke automated web-based intervention that maximised handwashing intention, monitored handwashing behaviour, provided tailored feedback, reinforced helpful attitudes and norms, and addressed negative beliefs. We enrolled participants into an additional cohort (randomised to receive intervention or no intervention) to assess whether the baseline questionnaire on handwashing would affect handwashing behaviour. Participants were not masked to intervention allocation, but statistical analysis commands were constructed masked to group. The primary outcome was number of episodes of RTIs in index participants in a modified intention-to-treat population of randomly assigned participants who completed follow-up at 16 weeks. This trial is registered with the ISRCTN registry, number ISRCTN75058295.

Findings
Across three winters between Jan 17, 2011, and March 31, 2013, we enrolled 20 066 participants and randomly assigned them to receive intervention (n=10 040) or no intervention (n=10 026). 16 908 (84%) participants were followed up with the 16 week questionnaire (8241 index participants in intervention group and 8667 in control group). After 16 weeks, 4242 individuals (51%) in the intervention group reported one or more episodes of RTI compared with 5135 (59%) in the control group (multivariate risk ratio 0·86, 95% CI 0·83–0·89; p<0·0001). The intervention reduced transmission of RTIs (reported within 1 week of another household member) both to and from the index person. We noted a slight increase in minor self-reported skin irritation (231 [4%] of 5429 in intervention group vs 79 [1%] of 6087 in control group) and no reported serious adverse events.

Interpretation
In non-pandemic years, an effective internet intervention designed to increase handwashing could have an important effect in reduction of infection transmission. In view of the heightened concern during a pandemic and the likely role of the internet in access to advice, the intervention also has potential for effective implementation during a pandemic.

via An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial – The Lancet.

Short summary card increases staff knowledge about infection control

Transmission-based precautions are designed to interrupt the transmission of pathogens. Success relies on early recognition of patients with potentially infectious conditions and prompt action. Researchers from Scotland examined the value of a transmission-based precautions reminder card for healthcare workers. Staff at one hospital were surveyed about implementing transmission-based precautions. After this, staff were issued with a guidance card summarising local transmission-based precautions guidelines. They were invited to carry the card with them as a reminder. Staff were resurveyed later to assess impacts. The card was associated with improved staff ability to decide which transmission-based precautions were required in various situations.
Reference: Russell CD, et al. Healthcare workers’ decision-making about transmission-based infection control precautions is improved by a guidance summary card. The Journal of Hospital Infection. 2015. 90(3): 235 – 239

Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications.

BACKGROUND: Although intravenous therapy is one of the most commonly performed procedures in hospitalized patients, it remains susceptible to infectious and non-infectious complications. Previous studies investigated peripheral intravenous catheter (PIVC) complications mainly in pediatrics, but apparently none were investigated among Saudi adult populations. The aim of this study was to assess the pattern and complications of PIVCs at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.

METHODS: An observational prospective cohort study investigated PIVCs pattern and complications among adults with PIVCs, admitted to various wards at KAMC. PIVCs-related clinical outcomes (pain, phlebitis, leaking, and others) were recorded in 12-hour intervals, using the Visual Inspection Phlebitis scale. Density incidence (DI) and cumulative incidence (CI) of complications and their relative risks (RRs) were calculated. Regression analyses were applied and significance limits were set at P<0.05.

RESULTS: During the study period, 359 adults were included, mounting to 842 PIVCs and 2,505 catheter days. The majority of patients, 276 (76.9%), had medical, chief admission complaints, whereas 83 (23.1%) were trauma/surgical and infectious cases. Complicated catheters were found in 141 (39.3%) patients, with 273 complications (32.4/100 catheters), in 190 complicated catheters (CI =22.56/100 catheters and DI =75.84/1,000 catheter days). Phlebitis ranked first among complications, 148 (CI =17.6%), followed by pain 64 (CI =7.6%), leaking 33 (CI =3.9%), dislodgement 20 (CI =2.4%), and extravasations and occlusion 4 (CI=0.5% each). Phlebitis was predicted with female sex (P<0.001), insertion in fore/upper arm (P=0.024), and infusion of medication (P=0.02). Removal time for PIVCs insertion was not a significant predictor of phlebitis (RR =1.46, P=0.08).

CONCLUSION: Incidence of complications in this study was significantly higher than rates in previous studies. Better insertion techniques may be sought to lower the incidences of PIVC complications, thus extending their onset beyond day 3. Changing catheters is recommended when clinically indicated rather than routinely post-72 hours.

Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications. Abolfotouh MA, Salam M, Bani-Mustafa A, White D, Balkhy HH. Ther Clin Risk Manag. 2014 Dec , vol 8, no 10, p993-1001