title: Daily 2% chlorhexidine gluconate bath wash in a tertiary adult intensive care and high dependency units to reduce risk of hospital acquired multi resistant organisms: a best practice implementation project.
abstract: BACKGROUND
  There is growing evidence that the incidence of hospital acquired multi resistant organisms are increasing worldwide. Intensive care patients are particularly prone to hospital-acquired infections. In an effort to combat increasing nosocomial infections rates within the intensive care/high dependency unit setting, Canberra Hospital has implemented a daily 2% chlorhexidine gluconate bath wash in combination as part of a best practice policy to reduce hospital acquired multi resistant organism rates of colonization. This project focused on auditing the extent to which the protocol was implemented and on promoting its implementation.
  
  
  OBJECTIVE
  The primary aim of this evidence implementation project was to promote best practice in the use of 2% chlorhexidine gluconate body cleansing in the Canberra Hospital intensive care unit and high dependency unit settings. A secondary aim was to improve intensive care/high dependency unit patient outcomes and resource utilization.
  
  
  METHODS
  The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in 2% chlorhexidine gluconate wash health practice. A baseline audit was conducted followed by a three-prong education approach strategy targeted at clinicians and finalized using a follow-up audit.
  
  
  RESULTS
  There was an improvement in best practice for all criteria monitored in the follow-up audit compared to the initial audit. The most significant improvement was education and allergy assessment with 90% and 46% improvements respectively. Wipe application compliance improved by 28% to 55%, suggesting a need for continual education. Minor decreases in compliance were also noted in allergy documentation and application technique by 2% and 7% respectively.
  
  
  CONCLUSIONS
  The project was successful in increasing knowledge surrounding 2% chlorhexidine gluconate wash administration and has provided a future direction for sustaining evidence-based practice change. Further audits will need to be carried out in order to maintain the practice change and support sustained implementation of the best practice protocol.
authors.affiliation: The Australian Capital Regional Centre for Evidence Based Nursing and Midwifery Practice: an Affiliate centre of The Joanna Briggs Institute.|Intensive Care Unit, Canberra Hospital, Canberra, Australia.
authors.forename: Lizanne
authors.initials: L
authors.lastname: Dalgleish
authors.affiliation: Intensive Care Unit, Canberra Hospital, Canberra, Australia.|General Surgery, Canberra Hospital, Canberra, Australia.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Jhattu
authors.affiliation: Joanna Briggs Institute, Faculty of Health Sciences, University of Adelaide, Australia..|Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange.
authors.forename: Judith Streak
authors.initials: JS
authors.lastname: Gomersall
mesh_terms: D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D001494:Baths; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D012307:Risk Factors
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: 2% chlorhexidine gluconate; HDU; ICU; best practice; chlorhexidine gluconate washcloths; multi resistant organisms; nosocomial infection