CHanGing BathS

Project Page Title:  CHanGing BathS

Project By-line:  CHlorhexidine Gluconate Bathing Intervention to Decrease System-wide Central Line Associated Blood Stream Infections

 Introduction Paragraph: A long-standing question in health care is how to implement evidence into practice in an efficient, equitable, timely and patient-centered way. One major quality gap for many hospitals is CLABSIs. Daily bathing of patients at high risk for infection with Chlorhexidine Gluconate (CHG) cloths has been shown to significantly reduce risk of CLABSIs; however, implementation of this practice varies widely. 

Objectives:  The primary objectiveof this study is to assess the effect of a customized, multifaceted QI program on compliance with daily CHG bathing per the AHRQ protocol in inpatient units that admit critically ill patients.  Further, we will assess the effect of this program on nursing staffs’ perception of the importance of CHG bathing. 

The secondary objectiveis to examine the effect of the QI program on CLABSI rates.   

Design: Multi-center cluster randomized clinical trial with a step-wedge design. Unit of randomization is hospital unit.

Metrics:

• Compliance of daily CHG bathing documentation (measured via documentation audits)
• Nursing staffs’ perceptions of CHG bathing (measured via a Qualtrics pre- and post-survey of 24 total questions; 12 demographic and 12 related to CHG bathing)
• CLABSI rates (measured via current NHSN processes)

Methods: A step-wedged design will be used with units clustered into 4 sequences and enrolled over the course of 4 months (n=12 units; DUH sites include: 8E, 7W, 6W, 7700, 9100, PCICU, PICU, Peds BMT; other units will be at Wake Med). 

Units will receive the active implementation strategies of audit and feedback and educational outreach visits, detailed in the intervention protocol.

Timeline:Trial enrollment and hospital (site) assessments begin May, 2019 and are carried out over the subsequent 6 months of unit-participant follow-up (4 months intervention and 2 months sustainability measures). Stratified randomization will be used to ensure that selected hospital unit characteristics are balanced within each sequence.

Project Leads: Staci Reynolds (Staci.reynolds@duke.edu) and Pat Woltz (pwoltz@wakemed.org)