EBP paper
Chlorhexidine Bathing to Reduce Central-Line-Associated Bloodstream Infections
An evidence-based practice proposal applying the Iowa Model to daily CHG bathing as a CLABSI-reduction intervention in the ICU.
Clinical Problem and Trigger
Central-line-associated bloodstream infections (CLABSIs) remain among the most preventable and most lethal healthcare-associated infections, extending length of stay and driving attributable mortality in the intensive care unit (ICU). Using the Iowa Model of Evidence-Based Practice, a problem-focused trigger — a unit CLABSI rate exceeding the national benchmark over two consecutive quarters — prompted this appraisal of daily chlorhexidine gluconate (CHG) bathing as an adjunct to the standard central-line bundle.
PICOT question
In adult ICU patients with a central venous catheter (P), does daily bathing with 2% chlorhexidine gluconate (I) compared with routine soap-and-water bathing (C) reduce the incidence of CLABSI (O) over a three-month period (T)?
Evidence Appraisal
A cluster-randomized crossover trial found that daily bathing with CHG-impregnated cloths significantly reduced the rate of hospital-acquired bloodstream infections compared with non-antimicrobial washcloths (Climo et al., 2013). Using the Johns Hopkins appraisal tool, this body of evidence rates as Level I with good quality, and the effect is consistent across multiple ICU populations, supporting a strong recommendation for adoption.
28%
Relative reduction in bloodstream infection with daily CHG bathing (Climo et al., 2013)
Proposed Practice Change and Evaluation
The proposal standardizes daily 2% CHG bathing for all adult ICU patients with a central line, embedded in the existing bundle and documented on the electronic flowsheet. Implementation pairs a nurse-led education module with competency validation. Outcome evaluation tracks the CLABSI rate per 1,000 central-line days over three months against the pre-intervention baseline, with process measures for bathing compliance and skin-integrity monitoring.
Anticipated barriers include concern about skin irritation and workflow disruption during high-acuity shifts. Mitigation includes a documented skin-assessment step and framing CHG bathing as a substitution for — not an addition to — routine bathing, preserving nursing time while raising the standard of infection prevention.