Routine Chlorhexidine Bathing to Prevent Central Line Infections in a Level IV NICU
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Problem: Central line infection rates remain high in neonatal intensive care units (NICU) despite unit quality improvement changes. Chlorhexidine gluconate (CHG) is a broad-spectrum topical antiseptic that is used in many different clinical settings to prevent infections. Careful use of routine two percent CHG bathing (wipes) should be considered as a solution for eliminating, or significantly decreasing, central line-associated blood stream infections (CLABSI) found in level IV NICU populations. The question proposed was if this technique is a safe practice on infants born prematurely or at a low birth weight?|Methods: This was a quality improvement project to evaluate CHG bathing as part of a multifaceted approach to reduce CLABSIs in a NICU setting. Eligible infants were bathed every 3 days with two 2% CHG wipes (Sage®, Cary, IL). Infant skin scores were assessed once each nursing shift with the Neonatal Skin Condition Score and documented in the patient’s electronic medical record. If a patient achieved a score ≥ 7 on the scale (range 3-9), they no longer received CHG baths. All patients in the Children’s Hospital and Medical Center’s NICU with central venous access including central venous lines (CVLs), and peripherally inserted central catheters (PICCs) as well as umbilical artery and umbilical venous catheters (UACs and UVCs) were included in the sample for CHG bathing. Infants born prior to 28 weeks gestational age needed to be ≥ 14 days of life to begin the CHG bathing. An additional component of this study involved an anonymous nursing survey conducted before and every three months during the study. This survey assessed nursing knowledge, concerns, barriers and importance ranking of CHG bathing.|Results: The central line infection rate decreased by 28.6% in the first three months of the study in this level IV NICU in a midwestern pediatric hospital. Within the months of October, November and December 2014, there were 5 reported CLABSIs as compared with 7 CLABSIs for the same months of 2013. The study is ongoing and CLABSI rates will continue to be assessed throughout the duration of the study. As of this date, no patient has suffered skin breakdown or other side effects from the use of the CHG bathing wipes. In terms of nursing knowledge, an increase was seen in the nurse’s perception of how important bathing is to the overall health of the patient as well as the knowledge as to how CHG works.|Conclusions: A decrease in overall CLABSIs was noted within this level IV NICU however five infections were still noted. The continuation of this quality improvement project throughout the next year will continue to provide more information about the efficacy of CHG bathing in this population. Nursing perception on the importance of bathing has also increased, as well as the general knowledge about the impacts of CHG on the patient. An area that was difficult to assess is nursing compliance with documenting that bathing was completed Monday, Wednesday and Friday on eligible patients. Further research could be completed on the implications of continued exposure to CHG and the effects on the neonate.
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