Impact of measurement and feedback on chlorhexidine gluconate bathing among intensive care unit patients: A multicenter study.

Autor:	Rhee Y; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Hayden MK; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Schoeny M; Department of Community, Systems, and Mental Health Nursing, College of Nursing, Rush University Medical Center, Chicago, Illinois., Baker AW; Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina., Baker MA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.; Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts., Gohil S; Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California., Rhee C; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.; Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts., Talati NJ; Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania., Warren DK; Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri., Welbel S; Division of Infectious Diseases, Cook County Health, Chicago, Illinois., Lolans K; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Bahadori B; Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine, California., Bell PB; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Bravo H; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Dangana T; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Fukuda C; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Habrock Bach T; Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri., Nelson A; Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina., Simms AT; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Tolomeo P; Division of Infectious Diseases, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pennsylvania., Wolf R; Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts., Yelin R; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois., Lin MY; Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	Infection control and hospital epidemiology [Infect Control Hosp Epidemiol] 2023 Sep; Vol. 44 (9), pp. 1375-1380. Date of Electronic Publication: 2023 Sep 13.
DOI:	10.1017/ice.2023.177
Abstrakt:	Objective: To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs). Design: A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods). Setting: The study was conducted across 7 geographically diverse ICUs with routine CHG bathing. Participants: Adult patients in the medical ICU. Methods: CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations. Results: We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions ( P < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions ( P < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline ( P < .001). Conclusions: Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.
Databáze:	MEDLINE
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