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Multicenter Study
. 2023 Sep;44(9):1375-1380.
doi: 10.1017/ice.2023.177. Epub 2023 Sep 13.

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

Yoona Rhee  1 , Mary K Hayden  1 , Michael Schoeny  2 , Arthur W Baker  3 , Meghan A Baker  4   5 , Shruti Gohil  6 , Chanu Rhee  4   5 , Naasha J Talati  7 , David K Warren  8 , Sharon Welbel  9 , Karen Lolans  1 , Bardia Bahadori  6 , Pamela B Bell  1 , Heilen Bravo  1 , Thelma Dangana  1 , Christine Fukuda  1 , Tracey Habrock Bach  8 , Alicia Nelson  3 , Andrew T Simms  1 , Pam Tolomeo  7 , Robert Wolf  5 , Rachel Yelin  1 , Michael Y Lin  1 ; CDC Prevention Epicenters Program
Affiliations
Multicenter Study

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

Yoona Rhee et al. Infect Control Hosp Epidemiol. 2023 Sep.

Abstract

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.

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Conflict of interest statement

M.K.H. has been a coinvestigator on several research studies for which Sage Products (now part of Stryker Corporation), Molnlycke, and Medline provided chlorhexidine products at no charge to hospitals and skilled nursing facilities participating in the research. Neither M.K.H. nor her employer (Rush University Medical Center) received chlorhexidine products. S.G. is a coinvestigator on a study in which participating hospital and nursing homes received contributed antiseptic product from Stryker (Sage Pharmaceuticals), Clorox, Medline, and Xttrium; companies had no role in the design, conduct, analysis, or publication of these studies. C.R. reports royalties from UpToDate, Inc, and consulting fees from Pfizer and Cytovale for topics unrelated to this study. D.W. was a consultant for Molynlycke Health Care AB after completion of the study. M.Y.L. has received research support in the form of contributed product from Sage Products (now part of Stryker Corporation).

Figures

Figure 1.
Figure 1.
Timeline of point-prevalence surveys during baseline and intervention periods.
Figure 2.
Figure 2.
Modeled chlorhexidine gluconate (CHG) skin concentration measurements on 681 intensive care unit (ICU) patients during baseline and intervention periods. CHG skin concentrations are expressed in means (solid lines) and 95% confidence intervals (dotted lines) on 3 body sites (neck, axilla, inguinal region) combined. The first 3 surveys occurred without any feedback (baseline period), followed by surveys 4–6 during which feedback of CHG skin concentrations and bathing education occurred (intervention period). Month 0 corresponds to the time when the first set of CHG skin concentration results was made available to each ICU for feedback. For ICUs that used 2% CHG-impregnated cloths, there was a 3-fold increase in mean CHG skin concentration between the baseline and intervention periods. This difference was not seen with use of 4% liquid/foam CHG formulations.
Figure 3.
Figure 3.
Chlorhexidine gluconate (CHG) skin concentration ranges on intensive care unit (ICU) patients during the intervention period. In total, 599 swab samples were collected for 2% CHG-impregnated cloths and 367 swabs were collected for 4% CHG liquid/foam. Includes all ICU patients who received at least 1 CHG bath during the intervention period.
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