Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI; William S. Middleton Memorial Veterans Hospital, Madison, WI.
Am J Infect Control. 2021 Jun;49(6):775-783. doi: 10.1016/j.ajic.2020.12.012. Epub 2020 Dec 25.
Daily use of chlorhexidine gluconate (CHG) has been shown to reduce risk of healthcare-associated infections. We aimed to assess moving CHG bathing into routine practice using a human factors approach. We evaluated implementation in non-intensive care unit (ICU) settings in the Veterans Health Administration.
Our multiple case study approach included non-ICU units from 4 Veterans Health Administration settings. Guided by the Systems Engineering Initiative for Patient Safety, we conducted focus groups and interviews to capture barriers and facilitators to daily CHG bathing. We measured compliance using observations and skin CHG concentrations.
Barriers to daily CHG include time, concern of increasing antibiotic resistance, workflow and product concerns. Facilitators include engagement of champions and unit shared responsibility. We found shortfalls in patient education, hand hygiene and CHG use on tubes and drains. CHG skin concentration levels were highest among patients from spinal cord injury units. These units applied antiseptic using 2% CHG impregnated wipes vs 4% CHG solution/soap.
Non-ICUs implementing CHG bathing must consider human factors and work system barriers to ensure uptake and sustained practice change.
Well-planned rollouts and a unit culture promoting shared responsibility are key to compliance with daily CHG bathing. Successful implementation requires attention to staff education and measurement of compliance.
每天使用葡萄糖酸洗必泰（CHG）已被证明可降低医疗保健相关感染的风险。我们旨在通过人为因素方法评估将 CHG 沐浴纳入常规实践。我们评估了退伍军人健康管理局非重症监护病房（ICU）环境中的实施情况。
我们的多案例研究方法包括退伍军人健康管理局的 4 个环境中的非 ICU 病房。我们遵循患者安全系统工程倡议，通过焦点小组和访谈来捕捉日常 CHG 沐浴的障碍和促进因素。我们通过观察和皮肤 CHG 浓度来衡量合规性。
每日 CHG 的障碍包括时间、对增加抗生素耐药性的担忧、工作流程和产品问题。促进因素包括拥护者的参与和单位的共同责任。我们发现患者教育、手卫生和管/引流管上 CHG 使用方面存在不足。脊髓损伤病房的患者皮肤 CHG 浓度最高。这些病房使用 2% CHG 浸渍湿巾而非 4% CHG 溶液/肥皂进行消毒。
实施 CHG 沐浴的非 ICU 必须考虑人为因素和工作系统障碍，以确保采用并持续改变实践。
精心策划的推出和促进共同责任的单位文化是遵守每日 CHG 沐浴的关键。成功实施需要关注员工教育和合规性的衡量。
