Hospital-acquired infections and thermally injured patients: chlorhexidine gluconate baths work.
BACKGROUND
Thermally injured patients are at high risk for infections, including hospital acquired infections (HAIs). We modeled a twice-daily chlorhexidine gluconate (CHG) bath protocol aimed at decreasing HAIs.


METHODS
Bathing with a 0.9% CHG solution in sterile water was provided twice daily as part of routine care. Institutional HAI prevention bundles were in place and did not change during the study. Baseline HAI rates were collected for 12 months before the quality study implementation. Centers for Disease Control and Prevention definitions for HAIs were used; our blinded Infection Control physician made each determination. This was an Institutional Review Board-exempt protocol.


RESULTS
The study cohort included 203 patients before the quality trial and 277 patients after the quality trial. The median burn area was 25% of total body surface area. Baseline HAI rates were as follows: ventilator-associated pneumonia, 2.2 cases/1,000 ventilator-days; cathether-associated urinary tract infection, 2.7 cases/1,000 catheter-days; central line-associated bloodstream infection, 1.4 cases/1,000 device-days. With implementation of this protocol, the rates dropped to zero and have stayed at that level with the exception of 1 cathether-associated urinary tract infection. There were no untoward effects or observed delays in wound healing with this protocol. All of these changes were clinically significant, although not statistically significant; the study was not powered for statistical significance.


CONCLUSIONS
Using this nurse-driven protocol, we decreased, in a sustainable manner, the HAI rate in our intensive care unit to zero. No integumentary difficulties or wound healing delays were related to this protocol.
Burn Center, Shands Hospital, University of Florida Health, Gainesville, FL.
Janet A
JA
Popp
Department of Critical Care Medicine, Geisinger Health System, Danville, PA. Electronic address: ajlayon@geisinger.edu.
A Joseph
AJ
Layon
Burn Center, Shands Hospital, University of Florida Health, Gainesville, FL.
Robert
R
Nappo
Division of Trauma and Burn Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL.
Winston T
WT
Richards
Division of Trauma and Burn Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, FL.
David W
DW
Mozingo
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001494:Baths / Q000379:methods*; D002053:Burn Units; D002056:Burns / Q000150:complications* / Q000188:drug therapy*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods; D064872:Patient Care Bundles / Q000379:methods; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
Burn unit; Catheter associated urinary tract infection; Central line associated blood stream infection; Infection control; Intensive care unit; Quality improvement; Ventilator associated event