2093. Chlorhexidine Gluconate Bathing to Prevent Central Line Associated Infections: What to Do When the Patient Can Bathe Themselves

Abstract

BackgroundBathing with pre-medicated 2% chlorhexidine gluconate (CHG) impregnated cloths is for prevention of central line associated blood stream infections (CLABSI). The use of CHG on patients outside of intensive care units has not been well studied. In our bone marrow and stem cell transplant unit (BMTU) we found compliance with CHG bathing to be lacking.MethodsThis was a quality improvement quasi-experimental pre-post intervention project to improve the use of CHG bathing for prevention of CLABSI in BMTU patients with central venous catheters (CVC). Review of CLABSI data identified high rates in BMTU compared with other units and significant numbers of Gram-positive organisms, suggesting needed increase in interventions directed at CVC maintenance. Review of cases, identified barriers to CHG bathing compliance. Audits of compliance with CHG bathing was performed pre-intervention. Interviews of staff and patients identified key barriers to compliance, which included, education on the benefit of CHG bathing in prevention of CLABSI, education of the potential for “sticky” feeling after bathing, education of staff on benefits and risk, and patient self-bathing education. Our implementation began in July 2016, and included, patient and staff education, a patient contract for use of CHG, daily patient signatures after bathing, signage in patient rooms with bathing instructions, and improved compliance parameters.ResultsCompliance with CHG bathing pre-intervention was 81%, and post was 93%. Definitions for compliance changed as part of implementation, to include patient signature, and reasons for noncompliance. CLABSI rate for the BMTU pre-intervention was 2.2/1,000 device days in 2015, post intervention 1.0/1000 device days in 2017 for a 55% reduction in CLABSI. Figure 1 illustrates the decline in CLABSI rate over time after the intervention. No concomitant interventions were implement during this period.ConclusionPatients outside of the ICU are typically nonventilated, awake and capable of self-bathing. Many interventions have been implemented to decrease CLABSI; however, the need for patient engagement and education in the implementation is a critical step that needs to be addressed to ensure fidelity and success of the intervention. Disclosures All authors: No reported disclosures.