Chlorhexidine

Gluconate Bathing
Sarah Brader
PICOT PRESENTATION
GNRS 507

Background
Nosocomial Infec>ons (HAIs)
MRSA acquisi>on rate in
2011 was 80,000 cases
causing 11,000 deaths
14% mortality rate.
The sta>s>cs have
decreased since 2005 when
an es>mated 125,000
people were hospitalized for
MRSA
It is projected that 6.4% of
pa>ents in cri>cal care
environments will acquire
some type of HAI during
their stay in the hospital.

MRSA acquisition
The repercussions of these infec>ons include the risk of sepsis; a
life-threatening condi>on that is dicult to treat, increased
length of hospitaliza>on and higher costs of care.
This is signicant because many insurance companies will not
reimburse if a secondary infec>on occurs within 48 hours
The Joint Commission established a Pa>ent Safety Goal in 2011
that posi>ve ac>on must be made to prevent the spread of HAIs

PICOT

In adult pa*ents in intensive care units (ICU), does

chlorhexidine gluconate (CHG) bathing compared to no
chlorhexidine gluconate bathing reduce the transmission of
methicillin-resistant staphylococcus aureus (MRSA) in a six
month stay?

Research Overview
1. Healthcare-associated infec>ons (HAIs)
MRSA vs. VRE
32-42% reduc>on rate

2. Types of Bathing
2% impregnated wipes
4% aqueous solu>on

3. Universal Decoloniza>on
Is MRSA screening necessary?

Hierarchy of Evidence

Grade II
Grade III
Grade IV
Grade V
Grade VI
Grade VII

Clinical Implications
Implementa>on Plan:
Studies with the highest reliability, consistent methodology, and
clearest outcome measurements.
Climo et al., 2009; Huang et al., 2014; Petlin et al., 2014

Present standard protocol to implement Thornton ICU at UCSD.

Rubin et al., 2013

Potential Limitations
Compliance:
Reported rate is LOW
Dene rou>ne bathing
Daily or 3 >mes per week?

Financial Burden:
CHG wipes cost 74% more than
the aqueous solu>on.
Convenience vs. Cost?

Expected Outcomes
Approved Criteria:
Reliability
Outcomes
Educa>on

MRSA acquisi>on (37% reduc>on)

P value 0.003 for Huang et al. 2013

Dene decoloniza*on
Educa>on & compliance
Adverse events:
Skin sensi>vity reac>ons:
7 out of 74,000 pa>ents

Further drug resistance

Ethical Considerations
Beneficence
Non maleficence
Informed Consent
Intubated or Mechanically
Ventilated patient considerations
Privacy and Confidentiality
Anonymity
Spiritual Considerations
Spiritual care
Isolation

Conclusion

Implemen>ng rou>ne chlorhexidine gluconate bathing in cri>cal

care environments:
reduces MRSA transmission
greatly improves life expectancy
reduces hospital revenue

Costs oset by benets

Researchers at Emory University argued that the cost of CHG would
be small in contrast to $1.5 million saved per year on HAI costs

JCAHO Incen>ve for Posi>ve ac>on

References
Armellino, D., Woltmann, J., Parmen>er, D., Musa, N., Eichorn, A.,
Silverman, R., . . . Farber, B. (2014). Modifying the risk: Once-a-day bathing
at risk pa>ents in the intensive care unit with chlorhexidne gluconate.
American Journal of Infec*on Control, 42(5), 571-573. doi:10.1016/j.ajic.
2013.12.026
Climo, M. W. Sepkowitz, K. A., Zuccoo, G., Fraser, V. J., Warren, D. K., Perl,
T. M., . . . Wong, E. S. (2009). The eect of daily bathing with chlorhexedine
on the acquisi>on of methicillin-resistant staphylococcus aureus,
vancomycin-resistant enterococcus, and healthcare-associated bloodstream
infec>ons: Results of a quasi-experimental mul>-center trial. Cri*cal Care
Medicine, 37(6), 1858-1865. doi:10.1097/ccm.013e31819e6d
Coyer, F.M., OSullivan, J., Cadman, N. (2011). The provision of pa>ent
personal hygiene in the intensive care unit: A descrip>ve exploratory study
of bed-bathing prac>ce. Australian Cri*cal Care, 24(3), 198-209. doi:
10.1016/j.aucc. 2010.08.001
Edmiston, C. E., Assadian, O., Spencer, M., Olmsted, R. N., Barnes, S. &
Leaper, D. (2015). To bathe or not to bathe with chlorhexedine gluconate: Is
it >me to take a stand for preadmission bathing and cleansing? AORN
Journal, 101(5), 529-538. doi:10.1016/j.aorn.2015.02.008

 Huang, S.S., Sep>mus, E., Kleinman, K., Moody, J., Hickok, J., Avery, T. R., . . . Plaq, R.
(2013). Targeted versus universal decoloniza>on to prevent ICU infec>on. New
England Journal of Medicine N Engl J Med, 368(24), 2255-2265. doi:10.1056/
nejmoa1207290.
Petlin, A., Schallom, M., Pren>ce, D., Sona, C., Man>a, P., Mcmullen, K., & Landhold,
C. (2014). Chlorhexidine gluconate bathing to reduce methicillin-resistant
staphylococcus aureus acquisi>on. Cri*cal Care Nurse, 34(5), 17-24. doi: 10.4037/
ccn2014943
Ritz, J., Pashnik, B., Padula, C., & Simmons, K. (2012). Eec>veness of 2 methods of
chlorhexedine bathing. Journal of Nursing Care Quality, 27(2), 171-175. doi:10.1097/ncq.
0b013e318239568
Rubin, C., Louthan, R. B., Wessels, E., Mcgowan, M., Downer, S., & Maiden, J. (2013).
Chlorhexidine gluconate. Cri*cal Care Nursing Quarterly, 36(2), 233-236. doi:10.1097/
cnq.0b013e31828404d1
Shah, H., Schwartz, J. L., Luna, G., & Cullen, D. L. (2016). Bathing with 2%
chlorhexedine gluconate; Evidence and costs associated with central line associated
bloodstream infec>ons. Cri*cal Care Nursing 39(1), 42-50. doi:10.1097/CNQ.
0000000000000096