Chlorhexidine gluconate bathing to reduce hospital-acquired infections in adult intensive care units: a best practice implementation project

ABSTRACT Introduction: Hospital-acquired infections (HAIs) have a significant effect on the quality of patient care as well as increasing hospital costs in adult intensive care units (ICUs). The ICU infection rate at the study hospital (10.6‰) exceeded acceptable standards. Aims: This study aimed to reduce the HAI rate in the adult ICU through chlorhexidine gluconate (CHG) bathing, in line with evidence-based practices. Methods: This project followed the JBI Evidence Implementation Framework, supported by JBI's Practical Application of Clinical Evidence System (PACES) and the JBI Getting Research into Practice (GRiP) tool. Rogers’ Diffusion of Innovations Theory was used to guide the change process. The study was conducted in a hospital in northern Taiwan. Baseline and follow-up audits were conducted involving 450 patients and 321 nurses across 12 adult ICUs. The audit criteria were derived from evidence-based recommendations. Results: Post-implementation audit compliance rates improved significantly. Daily bathing of ICU patients with CHG increased from 24% to 96%; education of nursing staff on CHG bathing increased from 30.5% to 100%; documentation of patient hypersensitivities and allergies to CHG increased from 40% to 98%; and use of non-chlorhexidine soap and water for patients allergic to CHG increased from 76% to 100%. Following implementation of the project, the monthly incidence density of HAIs decreased markedly from 10.6‰ to 6.1‰. Conclusions: The implementation of best practices significantly reduced HAIs in adult ICUs across the hospital. Key success factors included information technology, flat-structure communication, a top-down strategy, accountable management, and a centralized materials supply. These factors facilitated adoption of the project simultaneously across multiple units. Spanish abstract: http://links.lww.com/IJEBH/A378