IMPACT of Chlorhexidine Bathing on Hospital-Acquired Infections and Skin Tolerance Among STEM CELL Transplant Patients

Abstract

Central-line associated bloodstream infection (CLABSI) and Vancomycin-Resistant Enterococcus (VRE) colonization is not uncommon among Stem Cell Transplant (SCT) patients by nature of their underlying disease, immunodeficiency, and prolonged neutropenia. Chlorhexidine Gluconate (CHG) bathing has been extensively researched in the intensive care and medical/surgical units, but there is minimal literature regarding the oncology population, specifically SCT patients. Results of a literature review suggest that daily bathing with CHG may prevent hospital-acquired bloodstream infections and VRE colonization among SCT patients. The purpose of this quality improvement initiative was to evaluate the operational efficacy of a pilot implementation of daily CHG bathing in SCT patients. The secondary goal was to evaluate patient compliance, and to monitor the frequency and severity of CHG skin reactions. Sixteen patients on a 12-bed pod SCT unit were instructed to bathe daily with CHG wash during their admission for a two-month period. The nurses and nursing assistants on the unit were educated on the use of the CHG solution. All patients without known sensitivity to CHG 4% solution were educated by an RN during admission class and given instructions regarding CHG bathing and possible skin reactions. Active surveillance testing for VRE was obtained within 48 hours of admission and repeated weekly through rectal swabs. The infection-control preventionist investigated all suspected hospital-acquired infections (HAIs). Although CLABSI and VRE colonization rates post-implementation of daily CHG bathing were statistically not significant, the VRE infection rate remained low at 0.12 per 1,000 patient days. Compliance rate with CHG bathing was 90% whereas incidence of skin reactions was 0.06%. Results from this pilot demonstration suggest that CHG may be an effective strategy in reducing VRE colonization and preventing CLABSI and other infections in SCT patients. CHG is a well-tolerated solution and patient compliance is high. As a result, daily CHG bathing has been implemented throughout the 48-bed SCT unit. Further controlled studies can be conducted in this population to demonstrate difference in VRE colonization between daily CHG compared to soap and water bathing. In addition, cost-effectiveness can be evaluated.