scholarly journals The Use of 3.15% Chlorhexidine Gluconate/70% Alcohol Hub Disinfection to Prevent Central Line-Associated Bloodstream Infections in Dialysis Patients

2019 ◽  
Vol 24 (4) ◽  
pp. 33-36
Author(s):  
R. Marty Cooney ◽  
Nisha Manickam ◽  
Paul Becherer ◽  
Laura S. Harmon ◽  
Liza Gregg ◽  
...  
Keyword(s):  
Vascular Grafts ◽  
Bloodstream Infections ◽  
Central Line ◽  
Chlorhexidine Gluconate ◽  
Dialysis Patients

Highlights Using alcohol with CHG before accessing central line hubs helps reduce CLABSI events. Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events. A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.

The use of 3.15% chlorhexidine gluconate/70% alcohol hub disinfection to prevent central line-associated bloodstream infections in dialysis patients

2020 ◽  
Vol 29 (2) ◽  
pp. S24-S26 ◽  
Author(s):  
R. Marty Cooney ◽  
Nisha Manickam ◽  
Paul Becherer ◽  
Laura S. Harmon ◽  
Liza Gregg ◽  
...  
Keyword(s):  
Vascular Grafts ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Chlorhexidine Gluconate ◽  
P Value ◽  
Dialysis Patients ◽  
Skin Disinfection ◽  
Confounding Variables ◽  
Inpatient Population

Purpose: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. Methods: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. Results: The 5-year preintervention period (2008–2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013–2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. Limitations: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. Conclusions: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG

Central Line-Associated Bloodstream Infections in Non-ICU Inpatient Wards: A 2-Year Analysis

2015 ◽  
Vol 36 (4) ◽  
pp. 424-430 ◽  
Author(s):  
Yoona Rhee ◽  
Michael Heung ◽  
Benrong Chen ◽  
Carol E. Chenoweth
Keyword(s):  
Hematologic Malignancy ◽  
Significant Proportion ◽  
Total Mortality ◽  
Length Of Hospital Stay ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Central Line ◽  
Patient Specific ◽  
Dialysis Patients ◽  
Tertiary Teaching

OBJECTIVELittle is known about patient-specific factors contributing to central line-associated bloodstream infection (CLABSI) outside of the intensive care unit (ICU). We sought to describe these factors and hypothesized that dialysis patients would comprise a significant proportion of this cohort.DESIGNRetrospective observational study from January 2010 to December 2011SETTINGAn 880-bed tertiary teaching hospitalPATIENTSPatients with CLABSI in non–ICU wardsMETHODSCLABSI patients were identified from existing infection-control databases and primary chart review was conducted. National Health and Safety Network (NHSN) definitions were utilized for CLABSI and pathogen classification. CLABSI rates were calculated per patient day. Total mortality rates were inclusive of hospice patients.RESULTSOver a 2-year period, 104 patients incurred 113 CLABSIs for an infection rate of 0.35 per 1,000 patient days. The mean length of hospital stay prior to CLABSI was 16±13.3 days, which was nearly 3 times that of hospital-wide non-ICU length of stay. Only 11 patients (10.6%) received dialysis within 48 hours of CLABSI. However, 67% of patients had a hematologic malignancy, and 91.8% of those admitted with a malignant hematologic diagnosis were neutropenic at the time of CLABSI. Enterococcus spp. was the most common organism recovered, and half of all central venous catheters (CVCs) present were peripherally inserted central catheters (PICC lines). Mortality rates were 18.3% overall and 27.3% among dialysis patients.CONCLUSIONSIn patients with CLABSIs outside of the ICU, only 10.6% received dialysis prior to infection. However, underlying hematologic malignancy, neutropenia, and PICC lines were highly prevalent in this population.Infect Control Hosp Epidemiol 2015;00(0):1–7

High Prevalence of Reduced Chlorhexidine Susceptibility in Organisms Causing Central Line–Associated Bloodstream Infections

2014 ◽  
Vol 35 (9) ◽  
pp. 1183-1186 ◽  
Author(s):  
Nuntra Suwantarat ◽  
Karen C. Carroll ◽  
Tsigereda Tekle ◽  
Tracy Ross ◽  
Lisa L. Maragakis ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Chlorhexidine Gluconate ◽  
Infect Control Hosp ◽  
High Prevalence

In units that bathe patients daily with chlorhexidine gluconate (CHG), organisms causing central line–associated bloodstream infections (CLABSIs) were more likely to have reduced CHG susceptibility than organisms causing CLABSIs in units that do not bathe patients daily with CHG (86% vs 64%; P = .028). Surveillance is needed to detect reduced CHG susceptibility with widespread CHG use.Infect Control Hosp Epidemiol 2014;35(9):1183-1186

Journey to Zero Central Line-Associated Bloodstream Infections: An Intensive Care Unit's Story of Sustained Success and Quality Improvement

2016 ◽  
Vol 21 (2) ◽  
pp. 76-80 ◽  
Author(s):  
Leighann Jock ◽  
Laurie Emery ◽  
Lorri Jameson ◽  
Phyllis A. Woods
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Chlorhexidine Gluconate ◽  
Staff Education ◽  
Increased Risk ◽  
The Face ◽  
Sustained Success ◽  
Clabsi Rate

Abstract Background: Patients who have a central line (CL) are at increased risk for developing a CL-associated bloodstream infection (CLABSI), which increases morbidity, length of stay, and cost. Our goal is zero CLABSI infections. Methodology: In 2009 our organization implemented a CL bundle to prevent CLABSIs, and staff education was introduced in 2012. In 2013 a 2% chlorhexidine gluconate (CHG) wipe was introduced and used to clean around CL dressings. In 2014 a new CL dressing was adopted and during 2015 the organization began using a 3.15% CHG/70% alcohol swab for disinfection of needleless connectors. A final intervention was put into place in 2015 called “nose to toes” in which a patient is bathed from nose to toes (excluding the face) using 2% CHG wipes. Results: Before implementation of the above methods, our intensive care unit had an average infection rate of 1.9/1000 CL-days in 2009. Incidence of CLABSIs continued to decrease as the organization implemented the additional products and practices. In the 15 months following implementation, the ICU has been able to consistently maintain a zero CLABSI rate. Conclusions: The implementation of these changes in practice along with bringing in new products has made it possible to achieve the goal of reaching and maintaining zero infections. Due to the successful results in our intensive care unit, we have implemented these changes to all patient care areas in the hospital for use on all CLs.

scholarly journals Prevention of hospital-acquired bloodstream infections through chlorhexidine gluconate-impregnated washcloth bathing in intensive care units: a systematic review and meta-analysis of randomised crossover trials

2016 ◽  
Vol 21 (46) ◽  
Author(s):  
Elsa Afonso ◽  
Koen Blot ◽  
Stijn Blot
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Meta Analysis ◽  
Bloodstream Infections ◽  
Central Line ◽  
Chlorhexidine Gluconate ◽  
Cochrane Library ◽  
Gram Positive ◽  
Crossover Trials ◽  
Hospital Acquired

We assessed the impact of 2% daily patient bathing with chlorhexidine gluconate (CHG) washcloths on the incidence of hospital-acquired (HA) and central line-associated (CLA) bloodstream infections (BSI) in intensive care units (ICUs). We searched randomised studies in Medline, EMBASE, Cochrane Library (CENTRAL) and Web of Science databases up to April 2015. Primary outcomes were total HABSI, central line, and non-central line-associated BSI rates per patient-days. Secondary outcomes included Gram-negative and Gram-positive BSI rates and adverse events. Four randomised crossover trials involved 25 ICUs and 22,850 patients. Meta-analysis identified a total HABSI rate reduction (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.60–0.90; p = 0.002) with moderate heterogeneity (I2 = 36%). Subgroup analysis identified significantly stronger rate reductions (p = 0.01) for CLABSI (OR: 0.50; 95% CI: 0.35–0.71; p < 0.001) than other HABSI (OR: 0.82; 95% CI: 0.70–0.97; p = 0.02) with low heterogeneity (I2 = 0%). This effect was evident in the Gram-positive subgroup (OR: 0.55; 95% CI: 0.31–0.99; p = 0.05), but became non-significant after removal of a high-risk-of-bias study. Sensitivity analysis revealed that the intervention effect remained significant for total and central line-associated HABSI. We suggest that use of CHG washcloths prevents HABSI and CLABSI in ICUs, possibly due to the reduction in Gram-positive skin commensals.

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