623 The Impact of Chlorhexidine Baths, Scrub The Hub, and Daily Nursing Rounds on Catheter Associated Bloodstream Infections

Sunday, April 3, 2011: 4:00 PM
Cortez Ballroom (Hilton Anatole)
L. Silvia Munoz-Price, MD , University of Miami, Miami, FL
Mary Wyckoff, PhD, RN , University of Miami, Miami, FL
Joshua Lenchus, DO , University of Miami, Miami, FL
Laura Harris, RN , Jackson Memorial Hospital, Miami, FL
David Birnbach, MD , University of Miami, Miami, FL
Mara Rosalsky, RN , Jackson Memorial Hospital, Miami, FL
Gabriel Coro, RN , Jackson Memorial Hospital, Miami, FL
Cameron Dezfulian, MD , University of Miami, Miami, FL
Stephen Adams, RN , Jackson Memorial Hospital, Miami, FL

Background: Catheter associate bloodstream infections (CLABSIs) constitute one of the main hospital acquired infections in the United States.

Objective: Characterize the impact of subsequent interventions on the rate of CLABSIs within a surgical intensive care unit (SICU).

Methods: This retrospective study was performed in a 40-bed SICU within a 1,500 bed public teaching hospital. CLABSI rates were computed monthly from August 2008 to September 2010. The interventions implemented included: chlorhexidine (CHG) scrub the hub (2/2009), daily CHG baths (8/2009) and shift daily nursing rounds with the implementation of nursing goals sheet (2/2010). Scrub the hub consisted of a 15 second scrub of any central venous line being accessed using a 2% CHG/70% isopropyl alcohol applicator (Chloraprep, CareFusion, Texas). Alcohol wipes previously used for this purpose were removed from patient care areas after the inscrub the hub institution. SICU patients were bathed daily using cloths impregnated with 2% CHG (Sage Inc., Illinois). Both interventions were preceded by educational sessions. Daily nursing rounds were performed at each nursing shift change and throughout the day and were focused on ICU goals such as need of central lines, dressing changes, mouth care, necessity of urinary catheters, head of bed elevated, sedation vacation, etc. These nursing rounds were implemented as part of unit practice council and shared a Nursing Governance initiative. CLABSI data were grouped into 4 time periods (baseline, scrub the hub, CHG baths and nursing rounds) each beginning the month after initiation of the intervention. Data were analyzed by one-way ANOVA with post-hoc Bonferroni comparisons of all groups and post test for trend over the entire time period.

Results: The baseline rate of CLABSI (mean±SD: cases per 1000 catheter days) was 9.1±1.8. This rate decreased significantly throughout the study period (ANOVA p<0.001) with linear stepwise decreases noted with application of each additional intervention (post test for linear trend p<0.0001; slope=-1.3; R2=0.84). CLABSI rate decreased significantly (p<0.0001) with scrub the hub (rate: 4.7±0.8), followed by a nonsignificant decrease with CHG baths (rate: 3.4±0.6) and ending with a significant (p<0.0001) decrease with nursing rounds (rate: 0.6±1.1).

Conclusions: Sequential application of infection control protocols significantly reduced CLABSI rate in the SICU with the greatest effect noted with scrub the hub and nursing rounds.