University of Wisconsin School of Medicine and Public Health, Madison, WI.
William S. Middleton Memorial Veterans Hospital, and the Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Am J Infect Control. 2019 Jan;47(1):18-22. doi: 10.1016/j.ajic.2018.07.010. Epub 2018 Aug 31.
Many studies investigating daily chlorhexidine gluconate (CHG) bathing as an infection control intervention to decrease health care-associated infections have focused on reduction of infection and colonization; few studies have assessed CHG bathing compliance, work system factors, facilitators, and barriers to implementation.
This is a combination retrospective/prospective pilot study conducted at a large academic teaching hospital that implemented daily CHG bathing across all inpatient units. CHG compliance and patient refusal were calculated on the basis of documentation in the electronic medical record. We used the health belief model to guide semistructured interviews with patients about knowledge and barriers related to CHG bathing.
Of the 31 patients interviewed, 74% reported using CHG soap during their stay. Average compliance documented in the electronic medical record was 78% with a range of 57%-91% among all hospital units. Sixteen percent of patients declined CHG bathing, and refusal ranged from 3%-29% among all units. Major themes about CHG bathing from patient interviews include low perceived susceptibility to infection, high degree of trust in medical professionals, low knowledge of benefits of CHG, and low perceived self-efficacy in preventing HAIs.
Educating patients about CHG bathing appears to be a critical factor in decreasing patient refusal of CHG bathing.
许多研究都将每天使用葡萄糖酸氯己定（CHG）沐浴作为感染控制干预措施来降低医疗保健相关感染作为研究重点，主要集中在减少感染和定植上；很少有研究评估 CHG 沐浴的依从性、工作系统因素、促进因素和实施障碍。
这是一项在一家大型学术教学医院进行的回顾性/前瞻性试点研究，该医院在所有住院病房都实施了每天 CHG 沐浴。CHG 依从性和患者拒绝使用是根据电子病历中的记录来计算的。我们使用健康信念模型来指导对患者进行半结构化访谈，了解与 CHG 沐浴相关的知识和障碍。
在接受采访的 31 名患者中，有 74%的患者报告在住院期间使用了 CHG 肥皂。电子病历中记录的平均依从率为 78%，所有医院病房的依从率范围为 57%-91%。16%的患者拒绝使用 CHG 沐浴，所有病房的拒绝率范围为 3%-29%。患者访谈中关于 CHG 沐浴的主要主题包括对感染的低感知易感性、对医疗专业人员的高度信任、对 CHG 益处的低认知度以及预防 HAIs 的低自我效能感。
对患者进行 CHG 沐浴教育似乎是降低患者拒绝 CHG 沐浴的关键因素。
