Daily chlorhexidine baths were introduced on a 50-bed medical surgical unit to reduce central line-associated bloodstream infections (CLABSIs). CLABSIs contribute to increased mortality, length of stay, and costs. Literature shows that chlorhexidine baths as part of a CLABSI bundle can significantly reduce infection rates when used in preoperative and critical care areas. After implementing daily chlorhexidine baths for all patients with central lines, inconsistencies were found in bathing technique and documentation. Some patients refused baths due to feeling cold or itchy. While the program has been in place for four months, the unit's CLABSI rates have not decreased and remain above benchmark rates.

1. Wiping Away Blood Stream Infections: Chlorhexidine Baths in the
Medical Surgical Population
Elizabeth Thomas, MSN, RN, ACNS-BC
Stacey Doering, BSN, RN
Background to Problem Methods
Approach to the Problem
Barriers
Implications for Practice
 Central line associated blood stream infections (CLABSI) are
important and deadly Hospital Acquired Infections, with
reported mortality of 12%--25%
 CLABSIs contribute to extended length of stay and increased
cost of care
 In the United States it is estimated that three million central
lines are utilized each year, and that 250, 000 of those cases of
CLABSI occur outside of the critical care arena. As many as
70% may be preventable with evidenced based strategies
 Einstein Medical Center Philadelphia is a 700+ bed tertiary-
care, teaching institution located in urban Philadelphia,
Pennsylvania
 Tower Six is a 50 bed general medical surgical unit
 Chlorhexidine (CHG) baths have been in use for years in the
preoperative and critical care areas, but its use is relatively new
in the medical surgical arena. Daily CHG baths are an off-label
use of the product
 Literature shows that using CHG as part of a CLABSI bundle can
significantly reduce hospital-acquired infection rates (see
references)
 CHG binds to the surface of bacterial cells and disrupts the cell
membrane, leading to cell death
 CHG kills germs on skin for a longer time than regular soaps,
and is still effective when other body fluids such as blood are
present
 The CHG wipes are more effective than the CHG soap because
the delivered dose is uniform in the wipes, and the CHG is not
rinsed from the patient’s skin. The residual CHG on the skin
extends the potential for bacteria killing activity
 In May, 2015, Tower 6 medical/surgical unit began providing
CHG baths daily to all patients with central line access
 Ongoing observation of staff compliance of CHG bathing
technique and documentation
 Staff will be encouraged to perform peer review at shift-
to-shift handoff
 Internal CLABSI prevention bundle will be reviewed with
all nursing staff
 Continue to audit charts and evaluation of staff technique
References and
Acknowledgements
We would like thank the staff of Tower 6 and the Nursing Education and Professional
Development at Einstein Medical Center Philadelphia.
Climo, M. W. (2013). Effect of daily chlorhexidine bathing on hospital-acquired infection. The New
England Journal of Medicine, 368, 533-542. doi: 10.1056/NEJMoa1113849
Dixon, J. M. (2010). Daily chlorhexidine gluconate bathing with impregnated cloths results in
statistically significant reduction in central line-associated bloodstream infections. Am J Infect
Control, 38, 817-821.
O'Horo, J. C. (2012). The efficacy of daily bathing with chlorhexadine for reducing healthcare
associated bloodstream infections: A meta-analysis. Chicago Journal, 33(3), 257-267.
Vital Signs: Central Line--Associated Blood Stream Infections --- United States, 2001, 2008, and
2009. 60(08);243-248 . Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6008a4.htm.
Findings
 An education tool was developed regarding the importance
of CHG baths and how to provide them. All staff were
required to successfully pass a written test regarding the
education provided
 Staff were observed in use of the CHG baths and chart
audits were performed reviewing documentation
 There were inconsistencies in technique and documentation
of CHG baths
 There were a significant number of patient refusals of CHG
baths despite education as to the importance of infection
prevention
 Complaints that baths made patients feel cold or that
application caused itching were expressed. Some patients
stated that they felt “cleaner” when using soap and water
 Program in place for four months thus far
 Unit CLABSI rates have not decreased; one BSI attributed to
the target unit in past four months
 Unit CLABSI rates remain above the benchmark