Horizontal reduction of hospital acquired infections in the intensive care unit by replacing bed baths with chlorhexidine impregnated washcloths

Background:

Hospital Acquired Infections (HAIs) are preventable and can be reduced by implementing safe practices.  Yet hospitals continue to have growing number of infections and patients continue to be diagnosed with HAIs.  HAIs result in increased patient morbidity, mortality, and utilization of health care resources. Chlorhexidine gluconate (CHG) wipes when implemented for daily bathing in critical care units have been shown to reduce the risks of acquiring methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE).  

Objective:

The goal of this study was to evaluate the effectiveness of CHG impregnated wash cloths in reducing infections across the spectrum of all HAIs in the intensive care unit of the hospital.  We also wanted to evaluate cost effectiveness of the CHG was cloths versus traditional soap and water bathing, including utilization costs and estimate cost savings from HAI reduction. 

Methods:

In February 2010, daily bathing was replaced with CHG wash cloths for three months in the intensive care unit (ICU) of Riverside Regional Medical Center.  All HAIs such as MRSA, VRE, catheter-related urinary tract infection (CAUTI), Clostridium difficile (CDAD), central line related blood stream infections (CLABSI), and ventilator associated pneumonia (VAP) were monitored for the duration of the study.  Infection rates were compared for the three months prior to the study, and also the same time period last year (historical data).  All Patient Refined-Diagnostic Related Group (APR-DRG) scores were calculated to adjust for severity of illness and mortality.  Estimated cost savings from decreased HAIs were also identified.  

Results:

During the intervention period there was a reduction in most types of HAIs.  The infection rates had dropped from 21.3 to 12.8 per 1000 ICU days (when comparing historical data) and from 16.6 to 12.8 per 1000 ICU days (when comparing three months prior to the study).    Comparing the historical, pre-intervention, and study period, the rates of infections were:

MRSA:  6.2, 2.6, 1.8 (per 1000)

CDAD:  35.4, 26.1, 9.2 (per 10,000)

VRE:  1.8, 2.6, 1.8 (per 1000)

VAP:  3.5, 0, 0 (per 1000)

CLABSI:  0, 0.9, 0.9 (per 1000)

CAUTI:   3.5, 3.5, 2.7 (per 1000)

Conclusions:

Daily bathing of patients with CHG impregnated cloths reduced the risk of HAIs overall for the patients in the ICU.  The rate of HAI reduction appeared to be more in MRSA, CDAD, VRE, and CAUTI compared with VAP and CLABSI rate.   This intervention reduced costs to the unit and proved to be more cost effective than using bath basins.