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Running Head: THE EFFECTS OF CHG WIPES ON CAUTI INFECTION RATES

The Effects of CHG Wipes on CAUTI Infection Rates in Post-Surgical Patients

Brenna Halvorsen, Eunice Cho, Alexa Storcks

James Madison University


THE EFFECTS OF CHG WIPES ON CAUTI INFECTION RATES 2

Abstract

The following literature review discusses the impact of CHG wipes on rate of CAUTIs in

post surgical patients. A sum of six articles are reviewed and discussed. The main objective of

each article is to evaluate the effects of CHG on CAUTIs. It is important to realize the effect of

CAUTIs on patient cost and quality of care. Since 2008, hospitals do not receive reimbursement

from Medicare for healthcare-associated infections such as CAUTIs, which cost $150 to $450

million each year (Strouse, 2015). Starting in 2015, healthcare facilities that continue to

experience CAUTIs will be penalized through Medicare payment reductions. CAUTIs can

prolong a hospital stay or negatively impact the prognosis of a patient. It has been associated

with 13,000 deaths each year (Strouse, 2015). It is within a health care provider’s best interest to

ensure beneficence with every patient. Reducing the rates of CAUTIs in post surgical patients

would reduce the number of hospital days and complications. This will further impact overall

costs related to CAUTIs and improve quality of patient care. Currently, there is no evidence

based practice for preventing CAUTIs. The purpose of literature review is to evaluate the

current information of CAUTIs, recommend an appropriate course of action to, and overall

improve quality of care.


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Introduction

CAUTIs are catheter-associated urinary tract infections. In urinary tract infections, the

bladder, ureters, and the kidneys are affected. Traditional hygiene practices involve a basin,

soap, and warm water. In other facilities, CHG, or chlorhexidine gluconate wipes, are

used. CHG wipes are antiseptic and antimicrobial in nature and are used in certain facilities in

place of soap and water. The purpose of this literature review is to explore whether the use of

CHG wipes during baths in post-surgical patients decrease the rate of CAUTIs compared to

using soap and water alone.

Synthesis of the Literature

CHG did not significantly lower the rate of CAUTIs in adult surgical populations

(Strouse, 2015). The benefits of using CHG in comparison to water and soap was related to a

decreased of bacterial population in the basin baths. When used with other methods in a

“bundled” approach, CHG usage was found to lower CAUTI rate. However, it is impossible to

isolate the the CHG itself in isolation within the bundle. The limitations of the study included a

small sample size. A smaller sample size may skew conclusion/results (Strouse, 2015).

CHG baths did not reduce high - level bacteriuria, but significant differences were found

in high - level candiduria among men (Rupp, 2016). Generally, no differences were found in

low level bacteriuria. Major differences were associated with decolonization in men. The

minimal to no significant changes in decolonization among women may be related to anatomical

differences. Limitations of the study included the general number of studies separate from this

that had found no significant effects of CHG usage on CAUTI. The most relevant indicator of

CAUTI, symptoms of UTIs, was not measured. Lastly, potential variables and changes in

diagnostics were not considered within the study (Rupp, 2016).


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The next article to be discussed explores the effect of chlorhexidine bathing on hospital-

acquired infections in general medical patients (Kassakian, Mermel, Jefferson, Parenteau,

Machan, 2011). The limitations of the study were determined to be the low event rate, lack of

concurrent control group, no VRE screening compliance data, non-blinding by nursing and

infection control staff, and lack of bathing compliance data. The results of the experiment shows

that daily bathing with CHG wipes led to decreased rates of MRSA and VRE HAIs, which

shows that CHG wipes may be effective in preventing other infections in patients.

Another article assesses nursing interventions that are effective in reducing CAUTIs

(Oman, Makic, Fink, Schraeder, Hulett, Keech, Wald, 2012). Limitations include the risk for

confounding factors related to CAUTI rates due to the study being uncontrolled, the low amount

of present CAUTIs on the studied units, and the fact that the study only provides a brief glimpse

of the effectiveness of the interventions, rather than long term-effectiveness. It was found that

reinforcing evidence-based protocols and nursing interventions were effective in reducing the

rate of CAUTIs.

A randomized controlled crossover study that took place in an adult ICU in Nashville,

Tennessee, used a sample size of 9340 persons, comparing the use of CHG wipes to traditional

soap and water. There was no significant difference in the use of CHG wipes vs soap and water

in the incidence rate of CAUTIs (Noto, 2015). There was found to be a possibility of bias in the

study due to the fact that it was not a blinded study.

A meta-analysis made up of multiple already published studies was done. The studies

took place in multiple US hospitals, a Mexico-based hospital, and a French-based hospital. Up

to 15 studies were examined among adult intensive care units. Similar to the article described

above, the was no double-blinded method used, which could have caused bias. Only 3 of the
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trials were randomized controlled trials. There seems to be a significant difference in decreased

rate of CAUTIs when using CHG wipes over soap and water ( Huang, Chen, Wang, & He,

2016).

Conclusions

Overall, results were mixed on whether or not the usage of CHG wipes during routine

baths truly decrease the incidence of CAUTIs. In a study on general medical patients, it was

shown that the use of CHG is effective in reducing rates of MRSA and VRE, although no data

was presented on the effect on CAUTIs specifically. Another study showed that an effective

method of reducing CAUTIs was to reinforce evidence-based nursing interventions regarding

catheter care.

Recommendations

Recommendations include reinforcing current evidence based practices and minimizing

catheter duration to decrease CAUTI rates, and continuing research on prevention of

CAUTIs. There is not enough evidence to conclude significant factors of CHG on CAUTIs.

Reinforcing current evidence-based practices regarding catheter care is shown to decrease the

rate of CAUTIs. It is important as nurses to evaluate the necessity of foley catheters in patients

and to ensure that they are not used for excessive amounts of time, as this puts patients at higher

risk for infection. Due to the mixed results of this literature review, there is a need for more

research on how CHG wipes affect the rate of CAUTIs. Lack of standardized methods
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References

Huang, H., Chen, B., Wang, H., & He, M. (2016, November). The efficacy of daily chlorhexidine

bathing for preventing healthcare-associated infections in adult intensive care units. The Korean

Journal of Internal Medicine, 31(6): 1159–1170. doi:10.3904/kjim.2015.240

Kassakian, S., Mermel, L., Jefferson, J., Parenteau, S., & Machan, J. (2011). Impact of chlorhexidine

bathing on hospital-acquired infections among general medical patients. Infection Control and

Hospital Epidemiology, 32(3), 238-243. doi:10.1086/658334

Noto, M. J. (2015, January 27). Chlorhexidine Bathing and Infections. Journal of American Medicine,

313(4):369-378. doi:10.1001/jama.2014.18400

Oman, K. S., Makic, M. B. F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012). Nurse-

directed interventions to reduce catheter-associated urinary tract infections. American Journal of

Infection Control, 40(6), 548–553. https://doi.org/10.1016/j.ajic.2011.07.018

Rupp, M. E. (2016). Do chlorhexidine patient baths prevent catheter-associated urinary tract infections.

The Lancet: Infectious Diseases, 16(1), 8 - 9. https://doi.org/10.1016/S1473-3099(15)00244-3

Strouse, A. C. (2015). Appraising the literature on bathing practices and catheter - associated urinary

tract infection prevention. Urologic Nursing, 35(1), 11 - 17. doi.org/10.7257/1053-

816X.2015.35.1.11