Central-associated Blood Stream Infection (CLABSI) is one of the nurse-sensitive outcomes that is problem-prone in the hospital’s Intensive Care Unit (ICU). Patients with the central lines are bathed daily using 2 % chlorhexidine gluconate (CHG)-impregnated wipes, a component of the current practice bundle to prevent CLABSI, which has been proven to reduce the bioburden on the patient’s skin and thereby reduces the risk of central line site infection.
As part of an ongoing quality improvement initiative to address CLABSI in the ICU, the Evidence-Based Practice (EBP) Council, a clinical nurse-led structure at Kaiser Permanente Sacramento Medical Center, evaluated the evidence behind this practice. The council’s goal was to assess whether daily bathing with 2% CHG wipes, is still supported by the latest evidence.
To guide the clinical inquiry, the following PICOT question was formulated: In adult ICU patients with central lines (P), how does daily bathing using 2% CHG wipes (I), compared to standard soap-and-water bathing or no CHG bathing (C), reduce CLABSI rates?
Using the PICOT question, a literature review was conducted using PubMed, CINAHL, and Cochrane Library to identify studies matching the search criteria. The literature search yielded four studies- one systematic review and three randomized controlled trials—focused on 2% CHG wipes. A study using 4% CHG wipes was not included because of its higher concentration. After a literature search, studies were appraised using the Johns Hopkins EBP appraisal tool.
Following the appraisal and synthesis, the evidence suggests that daily CHG bathing reduces CLABSI rates compared to soap and water bathing. The findings support the current practice of daily CHG bathing of patients with central lines as part of the CLABSI prevention bundle, a set of interventions targeting various potential causes of CLABSI. Franco Balitaan, MSN, RN, CPAN, Chair of the EBP Council, shared: “EBP is not solely about adopting new interventions but also about questioning current practices within the context of a rapidly changing world of medicine and health care. The EBP Council members learned a lot taking on this topic as our first EBP clinical inquiry project.”