Daily CHG Bathing Initiatives Reduced CLABSI

At the 43rd Oncology Nursing Society Congress in Washington, DC, from May 17–20, Julia Olsen, MN, RN, CNL, from Froedtert Hospital, Milwaukee, Wis., presented the poster “A Bath a Day Keeps Infections Away: An Innovative Approach to Daily CHG Bathing on an Oncology Unit.” She describes the need for daily chlorhexidine gluconate (CHG) cloth bathing in the oncology population, to lower both rates and risks of infection.

As Olsen explains, it is important for nurses in inpatient settings to follow best-practice procedures for administering CHG baths, and to educate patients about why they are essential for prevention of infection. In her own daily practice on an inpatient hematology/oncology unit, the majority of CHG baths are provided by CNAs, followed by nurses and occupational therapists.

Data from her cancer center showed nurses were not consistently performing daily CHG cloth baths, nor explaining their important health benefits to patients. In addition, there was a subpopulation of patients on the unit who refused CHG bathing.

Olsen recognized a fundamental need to educate both nursing staff and oncology patients about why CHG bathing is particularly critical in patients with hematologic malignancies.

The poster explains that CHG can be used safely on lines, tubes, and devices, and the cloths can be wiped over occlusive dressings. It describes several considerations for effective implementation of CHG bathing, including where the wipes should be used (neck, shoulders, and chest; arms and hands; abdomen, groin, and perineum; legs and feet; and back of the neck, back, and then buttocks). Importantly, CHG cloths are never to be used above the jawline. In addition, the disinfectant, though sticky due to moisturizers impregnated in the cloths, should be allowed to air dry on the skin so patients benefit from the cloths’ antibacterial effects. CHG cloths should also be used to wipe down and disinfect the 6 inches of Foley/tubing that are closest to the patient, Olsen emphasizes.

In Olsen’s study, with the implementation of interprofessional collaboration, increased education, and proper documentation of bathing using the CHG cloths, the bathing compliance rates increased by 95% within 14 months. Notably, during this period an 8% decrease in central line–associated bloodstream infections (CLABSI) was observed. Compliance with the procedure for CHG bathing was enforced by the clinical nurse leader (CNL). As Olsen notes, “[s]everal other CLABSI prevention initiatives were also implemented [in] late 2017 so the unit anticipates more drastic decreases in CLABSI rates for 2018.”

These positive results were observed following increased patient acceptance of the procedure, and collaborative efforts by several interprofessional teams. Daily-practice improvements included providing patients with educational information about infection prevention through proper hygiene, as well as development of appropriate CHG bathing documentation and procedures to be followed by staff members.

Future goals are to create admission order sets that include “Daily CHG Bathing”; conduct maintenance bundle audits of both CHG bathing and CVAD (central venous access device) issues; and improve existing CLABSI initiatives, which currently consist of a “CLABSI Prevention Champions” self-challenge activity and the availability of a full-time CNA whose dedicated role is to assist staff in CHG bathing of patients.