Running head: THE BENEFIT OF CHLORHEXIDINE WIPES

The Benefit of Chlorhexidine Wipes in Patients with Venous Catheters Olivia Juola University of South Florida

THE BENEFIT OF CHLORHEXIDINE WIPES The Benefit of Chlorhexidine Wipes in Patients with Venous Catheters A very pertinent clinical issue in all hospitals today is the issue of hospital acquired infections. Many hospitals have protocols about hand hygiene, intravenous needle insertion, and using alcohol wipes to scrub the hub of IV tubing before beginning a new bag to prevent infections patients can get while staying in the hospital, but there is a protocol that has yet to be initiated in all hospitals: the use of chlorhexidine baths in patients with venous catheters. This is relevant and very significant to any hospital, because anyone with a venous catheter is at a high risk for infection, since the catheter ends close to or in the heart. With the use of daily chlorhexidine wipes, patients have a greater chance of being hospital-acquired infection free when they are discharged. The reason hospitals should want to implement this protocol is because although the wipes have a cost, it is not greater than the cost of having the patient hospitalized for a longer amount of time because of an infection caused by something placed during their stay. Since the

infections are hospital acquired, the insurance companies will not pay for the cost of treatment to get rid of that infection, so it costs the hospital a large amount of money. The hospital would be responsible for financing the wipes for each floor and the hospital board would have to approve the plan and budget. This led to the development of this PICOT question: In inpatient units, does the use of chlorhexidine daily baths decrease the number of hospital acquired catheter associated blood line infections? Synthesized Literature Review The search engine used to find information for this synthesis was PubMed. The key terms used in searching for relevant literature on the topic of chlorhexidine bathing were Chlorhexidine baths, CLABI, MRSA and VRE infections, and Chlorhexidine wipes.

THE BENEFIT OF CHLORHEXIDINE WIPES All three research studies showed a significant decrease in the number of catheter associated blood lines infections with the daily use of chlorhexidine baths (p < .05) (Climo, 2013; Dixon, 2010; Monteclavo, 2012). The significant reduction of infections is an outcome that is wanted with these studies. Two studies used a randomized control trial and multi-center

study (Climo, 2013; Monteclavo, 2012) and one used a single center (Dixon 2010). Multi-center studies typically help reduce bias. Dixon and Carver (2010) assessed the amount of money that the hospital saved by using the daily chlorhexidine baths, however the other two studies did not discuss this topic (Climo, 2013; Monteclavo, 2012). A gap that was found in the research is that not one of these studies addressed the effects of chlorhexidine wipes in regular units with patients who have central line catheters, instead of just intensive care and bone marrow transplant units. When doing the literature search not one study was found that addressed research in a unit outside of bone marrow transplant units or intensive care units. Proposed Practice Change The practice should be changed in the hospital so that every patient with a central catheter will have a daily bath with chlorhexidine wipes to help prevent catheter associated blood line infections. Based on The American Association of Critical Care Nurses (2013), this protocol is the best practice as found by research. Change Strategy In order to promote staff engagement in the hospital to follow this new protocol, a monitoring system will be used to ensure compliance. According to the Evidence Based Practice Model (Rosswum, 1999), planned ongoing monitoring on a unit is a part of successfully maintaining a practice change. Managers and infection control staff will be in charge of the continual monitoring of staff on the units where the change is implemented.

THE BENEFIT OF CHLORHEXIDINE WIPES Roll Out Plan The plan to roll out this new protocol is as follows: Steps Step One Definition Assess the need for practice change: Identify problem Collect data on current hospital practice Find the best evidence to change the practice: Review literature and previous studies done in other hospitals Critically analyze the evidence in literature Assess positives and negatives of each study done Assess potential cost and benefit for the hospital Design practice change The protocol needs to be brought to the hospitals board and the people in charge of the money on the units in order to get approval for having more money in the budget for the chlorhexidine wipes. Managers need to be informed of the new protocol and set up education sessions for the staff on their floor in order to teach the staff the proper use and rules of chlorhexidine wipes. Implement and evaluate practice change The time period for the data collection will depend on how long a patient is in the hospital, but from patient admission to patient discharge which could potentially be months from the start date. Maintain practice change The change will be continually monitored by managers and infection control staff to ensure compliance by the unit staff. Time Frame for Rollout Complete September 2013

Step Two

Completed September 2013

Step Three

Completed October 2013

Step Four

Completed October 2013

Step Five

Implemented October 2013 Evaluated April 2013

Step Six

Continually

A Model for Change to Evidence-Based Practice (Rosswum 1999) Project Evaluation The goal is to have a decreased number of catheter associated blood stream infections with in-patients who have any type of central catheter. The data will be collected by infection

THE BENEFIT OF CHLORHEXIDINE WIPES control staff member upon admission and discharge of the patient and analyzed by the research department of the hospital. The project will be assumed successful if there is a p value of less than .05, showing a significant decrease in the number of catheter associated blood line infections. Dissemination of Evidence Based Practice

In order to disseminate this information found from this project, conferences for hospital managers and leaders will be held to give the information on the new studies. If possible, the study can be reviewed by the institutional review board to be published as a study and distributed throughout peer reviewed journals for people to read. This information would be helpful for any hospital that has a high rate of catheter associated blood line infections and can be presented as a money saver and decrease readmissions for hospital departments as well.

THE BENEFIT OF CHLORHEXIDINE WIPES References American Association of Critical Care Nurses. (2013). American association of critical-care nurses updates patient bathing practices. Retrieved from http://www.aacn.org/wd/publishing/content/pressroom/pressreleases/2013/april-bathingpractice-alert-press-release.pcms?menu=

Climo, M.W., Yokoe, D.S., Warren, D.K., Perl, T.M., Bolon, M., Herwaldt, L.A., Wong, E.S. (2013). Effect of daily chlorhexidine bathing on hospital-acquired infection. The New England Journal of Medicine, 386, 533-542. Dixon, J.M. & Carver, R. L (2010). Daily chlorohexidine gluconate bathing with impregnated cloths results in statistically significant reduction in central line-associated bloodstream infections. American Journal of Infection Control, 38 (10), 817-821. Monteclavo, M.A., McKenna, D., Yarrish, R., Mack, L., Maguire, G., Haas, J., Wormser, G.P. (2012). Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability. The American Journal of Medicine, 125 (5), 505-511. Rosswurm, M.A., & Larrabee, J.H. (1999). A model for change to evidence-based practice. The Journal of Nursing Scholarship, 31(4), 317-322.