Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois.
Department of Community, Systems, and Mental Health Nursing, College of Nursing, Rush University Medical Center, Chicago, Illinois.
Infect Control Hosp Epidemiol. 2023 Sep;44(9):1375-1380. doi: 10.1017/ice.2023.177. Epub 2023 Sep 13.
To assess whether measurement and feedback of chlorhexidine gluconate (CHG) skin concentrations can improve CHG bathing practice across multiple intensive care units (ICUs).
A before-and-after quality improvement study measuring patient CHG skin concentrations during 6 point-prevalence surveys (3 surveys each during baseline and intervention periods).
The study was conducted across 7 geographically diverse ICUs with routine CHG bathing.
Adult patients in the medical ICU.
CHG skin concentrations were measured at the neck, axilla, and inguinal region using a semiquantitative colorimetric assay. Aggregate unit-level CHG skin concentration measurements from the baseline period and each intervention period survey were reported back to ICU leadership, which then used routine education and quality improvement activities to improve CHG bathing practice. We used multilevel linear models to assess the impact of intervention on CHG skin concentrations.
We enrolled 681 (93%) of 736 eligible patients; 92% received a CHG bath prior to survey. At baseline, CHG skin concentrations were lowest on the neck, compared to axillary or inguinal regions ( < .001). CHG was not detected on 33% of necks, 19% of axillae, and 18% of inguinal regions ( < .001 for differences in body sites). During the intervention period, ICUs that used CHG-impregnated cloths had a 3-fold increase in patient CHG skin concentrations as compared to baseline ( < .001).
Routine CHG bathing performance in the ICU varied across multiple hospitals. Measurement and feedback of CHG skin concentrations can be an important tool to improve CHG bathing practice.
评估测量和反馈葡萄糖酸氯己定（CHG）皮肤浓度是否可以改善多个重症监护病房（ICU）的 CHG 沐浴实践。
在 6 次点患病率调查（基线和干预期间各进行 3 次调查）期间测量患者 CHG 皮肤浓度的前后质量改进研究。
该研究在 7 个地理位置不同的 ICU 进行，这些 ICU 常规进行 CHG 沐浴。
内科 ICU 的成年患者。
使用半定量比色法测量颈部、腋窝和腹股沟区域的 CHG 皮肤浓度。从基线期和每个干预期调查的汇总单位水平 CHG 皮肤浓度测量值报告给 ICU 领导层，然后 ICU 领导层利用常规教育和质量改进活动来改善 CHG 沐浴实践。我们使用多水平线性模型评估干预对 CHG 皮肤浓度的影响。
我们招募了 736 名符合条件的患者中的 681 名（93%）；92%的患者在调查前接受了 CHG 沐浴。在基线时，与腋窝或腹股沟区域相比，颈部的 CHG 皮肤浓度最低（<0.001）。颈部 33%、腋窝 19%和腹股沟 18%的 CHG 未检出（身体部位之间的差异<0.001）。在干预期间，与基线相比，使用 CHG 浸渍布的 ICU 患者的 CHG 皮肤浓度增加了 3 倍（<0.001）。
多个医院的 ICU 常规 CHG 沐浴表现存在差异。测量和反馈 CHG 皮肤浓度可以是改善 CHG 沐浴实践的重要工具。
