Wednesday, March 24, 2010

Bath Time!


Archives has a retrospective review this month from a level I trauma center in Canada that studies the effect of daily bathing with chlorhexidine solution on the development of infectious complications in ICU patients. 286 patients were studied over 6 months. Here are the essential results:
Patients receiving chlorhexidine baths were significantly less likely to acquire a catheter-related bloodstream infection than comparators (2.1 vs 8.4 infections per 1000 catheter-days, P = .01). The incidence of VAP (ventilator associated pneumonia) was not affected by chlorhexidine baths (16.9 vs 21.6 infections per 1000 ventilator-days in those with vs those without chlorhexidine baths, respectively, P = .30). However, patients who received chlorhexidine baths were less likely to develop MRSA VAP (1.6 vs 5.7 infections per 1000 ventilator-days, P = .03). The rate of colonization with MRSA (23.3 vs 69.3 per 1000 patient-days, P < .001) and Acinetobacter (1.0 vs 4.6 per 1000 patient-days, P = .36) was significantly lower in the chlorhexidine group than in the comparison group.


The ICU nurses are just going to love this paper. Nothing fires them up more than the anticipation of doing a head to toe sponge bath on an inert, intubated patient in the ICU that takes four people to roll from side to side.

7 comments:

rlbates said...

As the size of the average person increases, it may actually take more than four people.

Anonymous said...

Have to anyway... got to be quick about it, though.
-SCRN

Anonymous said...

Brushing their teeth is supposed to help with the ventilator associated pneumonia.

Anonymous said...

You missed the point - the patients were ALREADY being bathe d- the only change was from a regular soap to a chlorhexidine soap.

Buckeye Surgeon said...

Anon 651pm-
I see where you're going with that. It's possible I've idiotically misinterpreted the study. But the truth is that bathing is not a standard daily nursing activity in most ICU's. If the patient has been there a while, starts to smell a bit, then yeah, you'll see a full body sponge bath being done. But really it's at the discretion of the nurse. A paper like this can prompt some gung ho physician/hospital executive to incorporate "chlorhexidine bathing" into the daily routine of all ICU patients. Because of the science, you see. Can't you envision a paper like this leading to the creation of a daily icu nurse "checklist"? I mean it might just lead to fewer infections, who knows....

Anonymous said...

Yup Buckeye, there is bathing going on to prevent infection and skin breakdown. It's a daily deal pretty much, certain areas more often :o) Really, the only hesitation on the part of the nurse would be due to the inability of the patient to tolerate/risk. Chlorhexidine bathing worries me. Don't know what kind of solution was being used... just don't like full body coverage.

-SCRN

Anonymous said...

at my facility chlorhexidine baths are a daily order for all icu pts.
-icu rn