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Chlorhexidine bathing suboptimal in ICU
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Preoperative and daily bathing with chlorhexidine of patients in an intensive care unit appeared inadequate, but could be improved through education and monitoring, according to recent findings.
Researchers assessed the effectiveness of chlorhexidine bathing at the Cleveland VA Medical Center before and after introducing an intervention aimed at educating and monitoring nurses and patients on chlorhexidine application. During the 6-month intervention, nurses were trained on preoperative chlorhexidine bathing, and they received feedback on chlorhexidine levels on patient skin. The nursing staff then educated patients on the need for preoperative bathing and appropriate bathing methods. A convenience sample of patients (n = 78) was evaluated for chlorhexidine levels and interviewed on the education they received.
Chlorhexidine levels were assessed through a colorimetric assay. The researchers used point prevalence surveys to identify the levels of chlorhexidine on the skin of medical and surgical ICU patients. They used Fisher’s exact test to compare the proportion of positive skin sites before and during the educational intervention.
During the intervention, the hospital introduced chlorhexidine cloths for all preoperative bathing. The intervention significantly increased the percentage of skin sites with detectable chlorhexidine (70% pre-intervention vs. 88% post-intervention; P < .001).
During the 4 months before intervention, the no-rinse cloths resulted in a greater proportion of skin sites with identifiable chlorhexidine compared with the chlorhexidine solution (70% with the cloths vs. 46% with the solution; P < .001). In the pre-intervention interviews, 26% of patients reported not receiving or understanding the instructions on chlorhexidine use.
Of 45 patients bathed with solution, 13% had no detectable chlorhexidine at any site, while 9% of 33 patients bathed with cloths had no detectable chlorhexidine at any skin site. For sites on which chlorhexidine was detected, the average concentration was higher with cloths than solution (65.4 ppm vs. 20.8 ppm; P < .01).
“In this study, a colorimetric assay provided a simple and rapid method of monitoring the performance of chlorhexidine bathing,” the researchers wrote. “In our facility, use of the assay identified deficiencies in both preoperative bathing and daily ICU bathing. Our experience suggests that routine monitoring and feedback on chlorhexidine application may be beneficial in facilities that use chlorhexidine for skin disinfection.” – by Jen Byrne
Disclosure: Supple reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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