2024 Article#2
Chlorhexidine Gluconate Baths: Supporting Daily Use to Reduce Central Line–Associated Bloodstream Infections Affecting Immunocompromised Patients
Background: Chlorhexidine gluconate (CHG) has a broad-spectrum antimicrobial property that has proven to be effective in prolonging skin antisepsis and decreasing pathogens often seen in oncology units.
Objectives: The aim was to reduce the incidence of central line–associated bloodstream infections in a hematology-oncology unit through the staff’s continued adherence to the institution’s protocol for CHG baths with wipes, and to identify barriers and the degree to which they interfered with optimal use of the CHG wipes.
Methods: The project focused on supporting staff and nurses by providing education and training on current practices to staff and patients, and identifying barriers. Direct observation and chart audits were the approach chosen to implement the project.
Findings: For the project study period, the unit had three nonpreventable bloodstream infections and zero preventable bloodstream infections.
Source taken from ONS Journal
Discussion Starting Points:
Please choose two for your response:
How does this research article compare to our practice, policy and or procedure?
What are the advantages and disadvantages to the proposed recommendations in the article?
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Was the correct method used? Why or why not?
How does this research article compare to our practice, policy and or procedure?
ReplyDeleteLast August 2024 our hospital implemented a new protocol to do CHG baths to all patients that has Central Lines and foley catheter with goal of preventing CLABSI and CAUTI. All caregivers were huddled to implement this new practice. A new audit tool was created and used every 12 hour shift.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Our hospital did utilized "direct observation" and "chart audits" each 12 hour shift to implement the CHG bath policy and caregivers became very intentional in implementing CHG baths and documenting them in the chart although sometimes there is a lack of education on the part of the patient from the caregivers which sometimes results in none compliance, but over all the outcome resulted on our hospital celebrating 100 days without CLABSI last December 2024.
How this research article compare to our practice, policy and or procedure?
ReplyDeleteOur hospital is been implementing CHG bath to all patients with central lines and Foley catheters to prevent CLABSI and CAUTI for a while.
However, this past year our hospital had far too many Hospital-acquired infections and to make sure that nurses are compliant with the policy audits to the CHG bath were implemented.
What are the advantages and disadvantages of implementing the article recommendations on your unit an or hospital?
CAUTI and CLABSI are serious infections causing a prolonged hospital stay, increased cost, and risk for mortality. The advantage of implementing this article is to decrease the impact of CLABSI and CAUTI for the patients and the hospital. Educating nursing stuff and follow up on the compliant with CHG bath helps to make a habit on a stuff to adhere to practice.
The disadvantage of implementing this article recommendations on our unit is that charge nurses are the one that have to do the audits. If there is a break nurse to help with visual part,
charge nurses have only the charting part to do. However, often there is no break nurse and the charge nurse have to do the whole auditing on her shift and is time consuming.
by Marzenna Messina
How does this research article compare to our practice, policy and or procedure?
ReplyDeleteThis research article differs from our current practice, policy, and or procedure because we still have a policy that says to flush with heparin prior to taking port-a-cath out.
What are the advantages and disadvantages to the proposed recommendations in the article?
The advange of using saline flushes as opposed to heparin flushes for port a cath line care in this article that it eliminates the incidence of unintentionally giving a patient heparin who could be allergic, also reduces herparin-induced thrombocytopenia and bleeding. Another advantage to using Normal Saline flushes would be to save money.
The only disadvantage that I could see would be if the patient had an occlusive clot, at which point you can give the port TPA or heparin.
sorry pls disregard this comment. It was for Article #1!!!
DeleteHow does this research article compare, to our practice, policy, and or procedure?
ReplyDeleteThis research article aligns with the PSJMC current comprehensive vascular access management; daily CHG bathing for all patients with a central line. It differs from the current practice on 6NE, bathing with 2% CHG impregnated wipes once a shift. Central audits were implemented by our new CNO are being done every shift; CL direct observation along with correct documentation in Epic.
What are the advantages or disadvantages to the proposed recommendations in the article?
CLABSIs are not only costly but one of the leading causes of mortality rates in hospitals across the country. The advantages of performing daily baths with CHG 2% impregnated wipes on patients with a central lines are apparent. Specifically, the oncology population is more susceptible to getting a CLABSI and implementing bundles to prevent CL infections can only benefit not only the patient, but the hospital.
How does this research article compare, to our practice, policy, and or procedure?
ReplyDeleteThis aligns with our policy to perform CHG baths every shift to patients with a central line.
What are the advantages and disadvantages to the proposed recommendations in the article?
DeleteThe advantages are well documented, twice daily audits ensure infection prevention. It also prompts nurses to examine if continued central line access is necessary. Disadvantages are that some patients dislike or have skin reactions to the CHG.
How does this research article compare to our practice, policy and or procedure?
ReplyDeleteHospital policy states to have CHG bath daily to patients with centra lines. However, on our floor we give CHG baths during each shift to ensure that the CHG bath does not exceed over 24 hours. Our hospital has also added a central line audit which assess per shift if CHG bath was done.
What are the advantages and disadvantages to the proposed recommendations in the article?
Advantages to this recommendation is to reduce CLABSI. Our hospital already follows this recommendation by implementing CHG bath for every patient with a central line. The disadvantages are to the patients that do not like the CHG, reporting itching and redness. There has been a patient that reported an allergy to CHG due to causing rashes on the skin, which increases their chances of getting a CLABSI.
How does this research article compare to our practice, policy and or procedure?
ReplyDeleteThe research article is congruent with our unit's practice based on our policy and procedure.We perform CHG baths or use CHG wipes every shift daily on patients in our unit that have central lines or foley catheter. In addition, there is an audit that is performed every shift to keep track of patients who have central lines and the staff's compliance in performing and documenting the use of CHG wipes/baths during patient care.
Was the correct method used? Why or why not?
Although the result was favorable, it the article lacks a few important information. For example, it didn't mention the number of patients with central lines that were studied. Also, the result of non-preventable infection that occurred even with the use of CHG baths, begs the question "what are the organisms that are resistant to CHG?" And, the frequency of use, to be effective or not effective was not addressed. In addition, does dressing changes, its frequency and quality affect the incidence of infection? i think the method was very limiting.
How does this research article compare to our practice, policy and or procedure?
ReplyDeleteThis research article is consistent with PSJMC's comprehensive approach to vascular access management. The hospital follows CDC and Infusion Nursing Society (INS) clinical standards to prevent CLABSI by requiring daily CHG baths for all patients with central lines. All caregivers are responsible for maintaining central lines in accordance with the CLABSI Prevention Bundle.
A daily audit is performed to ensure compliance with the CLABSI Prevention Bundle.
What are the advantages and disadvantages of implementing the article recommendations on your unit and/or hospital?
Implementing the article's recommendations for daily CHG bathing for all patients with central lines offers clear advantages in aligning with best practices from the CDC and Infusion Nursing Society (INS), which can significantly reduce the incidence of CLABSI and improve patient outcomes. This standardization of care, along with the reinforcement from daily audits, promotes a stronger culture of safety and accountability among staff. However, these benefits are balanced by several disadvantages, including the potential for patient skin irritation or allergic reactions to CHG, and the long-term risk of fostering CHG-resistant organisms. Moreover, the implementation requires a commitment of staff time and resources, which could be challenging on a busy unit, and some patients may refuse the daily baths, impacting full compliance.