Effectiveness of chlorhexidine bath in preventing central line infection

Author, Date, Title

Method and level of evidence

Types of patients and the enrolment period

Content of intervention

Study Findings Outcomes

Fouka, G. & Mantzorou, M. (2011). What are the Major Ethical Issues in Conducting Research? Is there a Conflict between the Research Ethics and the Nature of Nursing?

This is a systematic review of the data base of the Medline and the Nursing Cinahl

Level of evidence is 1

There is no control study used there were no specific period used but it was based on the review of the data base.

None

The most common types of ethical issues during the performance of a research work are informed consent, beneficence, respecting the anonymity as well as the confidentiality, and respecting the privacy. The nature of the nursing which focuses on the caring, prevention of the harm, and protection of the dignity as well as advocating the role of the nurses which is required in defending the rights of the participants, are from time to time incongruent with the ethics in the research work

Furuya, Y., Dick, A., Perencevich, E., Pogorzelska, M., Goldman, D., & Stone, P. (2011). Central line bundle implementation in US intensive care units and impact on bloodstream infections.

A cross-sectional study survey on the National Healthcare Safety Network (NHSN) hospitals

Level of evidence of this study is 1

Patients at the Intensive Care Units (ICU)

The enrolment period was ICU with a minimum of 500 device days

The use of Central Line (CL) Bundle elements throughout the US intensive care units

Hospitals had reported ICU-specific quarterly CLABSI rates as reported to the NHSN. Facilities were able to follow particular surveillance protocol which defines CLABSIs using the standard CDC terms.

Graling, P., & Vasaly, F. (2013). The effectiveness of 2% CHG Cloth Bathing for Reducing Surgical Site Infections

A prospective cohort study

Level of evidence is 3

Patients who had been taken through a general, vascular, and orthopedic surgery

There is no mentioning of the period used for the enrolment.

Using preoperative bathing with chlorhexadine gluconate (CHG) cloths in reducing the surgical site infections

There was an overall reduction in the rate of infection in the group that received 2 percent chlorhexidine gluconate bath before surgery. There was a reduction in the postoperative organ space infection even though the numbers of samples were smaller.

Jeanes, A., & Bitmead, J. (2015) Reducing bloodstream infection with a chlorhexidine gel IV dressing

Randomized controlled trial

Level of evidence is 4

The patients were those who had been admitted and were exposed to the intravenous catheter-related bloodstream infections

No specification of the enrolment period

The intervention was the used of the Tegaderm chlorhexidine gel IV for the Central Venous Catheters as well as the arterial line dressings

Tegaderm chlorhexidine gel IV for the Central Venous Catheters as well as the arterial line are effective for use in the high dependency and intensive care units for the reduction of the catheter related bloodstream infections

Kim, J., Holtom, P., & Vigen, C. (2011). Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: Epidemiologic and economic consequences

A case and a cohort study

Level of evidence is 4

Patients in the intensive care units and are at risk of acquiring catheter related bloodstream infections.

The period of the study was three years

The use of the central venous lines to control the catheter related bloodstream infections

There was a decrease in the infection rates. There was an improvement in the catheter related blood stream infection in all the intensive care units patients who participated in the study.

Klinworth, G., Stafford, J., O’Connor, M., Leong, T., Hamley, L., Watson, K., Kennon, J., Bass, P., Cheng, A. C., & Worth, L. (2014). Implementation of a successful hospital-wide initiative to reduce central line–associated bloodstream infections.

Randomized control trial study

Level of confidence is 4

The intensive Care Units (ICU) Patients who are at risk of acquiring the catheter related bloodstream infection

The time enrolment was 20 month period

Hospital-wide initiative (intensive care unit bundle)

Reduced rates of the catheter related bloodstream infections.

Kramer, N. (2016). Monitoring Central Line-Associated Bloodstream Infections [CLABSI] in Home Infusion

This is a systematic review of the descriptive as well as the qualitative studies

The level of evidence is 5

Patients at ICU who are exposed to the Catheter related bloodstream infections

No enrolment period mentioned

Monitoring Central Line-Associated Bloodstream Infections [CLABSI) in Home Infusion

The crafting of the surveillance system at home is somehow daunting. Working in isolation as home infusion provider is one of the great strides being made in the patient care leading to a reduce infections

McAlearney, A., Hefner, J., Robbins, J., Harrison, M., & Garman, A. (2013). Preventing central line-associated bloodstream infections: A Qualitative Study of Management Practices

Extensive qualitative cases study

Level of the evidence is 3

A total of 94 participants such as administrative leaders, clinical leaders, professionals, and the frontline physicians as well as nurses were interviewed

Comparing the higher and lower performing healthcare facilities on the basis of reducing the rate of central line associated blood stream infections

There were top level of commitmet, alignment of the physician and nurses, systematic education, use of the data, and the rewards as well as recognition in the high performing healthcare facilities.

Mermel, L. (2014). MRSA and CLABSI Compendium updates offer additional focus on implementation

This study is based on looking at the evidence produced by the Society for Healthcare Epidemiology of America based on the CLABSIs

The level of the evidence is 7

No enrolment period but it is based on looking at the CLABSIs infections to the patient at ICU

Engaging, educating, executing, ad evaluating the aspects of the CLABSIs

The updated guidance contains special parts with implementation, emphasis engagement with the healthcare personnel and vocal leaders who shares data with workers on the frontlines to help in tracking the prevention progress

Power, J., Peed, J., Burns, L., & Davis, M. (2012). Chlorhexidine bathing and microbial contamination in patients’ basin

Well designed controlled trial

Level of evidence is 3

The study was based on using patient’s bath basins with microbial contamination

The period for the culturing process was 5 days

Using Chlorhexidine in removal of the microbes for the purposes of preventing infections

Out of the 90 culture basins, there were 4 basins with positive microbial growth. The three organisms were identified as coagulase negative staphylococcus. This reveals that chlorhexidine is 95 percent effective for the prevention of the microbial infections.

Pyrek, K. (2015). Experts Address the Promise and Challenges of CHG Bathing Interventions

This was a review of the descriptive studies related to addressing the challenges of the CHG bathing interventions

The level of evidence of this study is 5

No enrolment period. The targeted patients in this case those who are exposed to CLABISs especially in ICU

Chlorhexidine gluconate interventions

Healthcare facilities are appropriately using the chlorhexidine gluconate to reduce the infections as well as controlling the spread of the antibiotic resistant microorganisms.

Quach, C., Milstone, A, Perpe, C., Bonenfant, M., Moore, D., & Perreault, T. (2014). Chlorhexidine Bathing in a tertiary care neonatal intensive care unit: Impact on central line–associated bloodstream infections

This was a randomized control trial study

The level of evidence is 4

Infants with the central venous catheter admitted to the neonatal intensive care unit

The enrolment period was April 2009 to March 2013

Chlorhexidine bathing in a tertiary care neonatal intensive care unit

There was a reduction I the CLABSI rates during the period of the intervention for the Chlorhexidine gluconate neonates. There were no reported adverse events.

Richardson, J., & Tjoelker, R. (2012). Beyond the central line-associated bloodstream infection bundle: the value of the clinical nurse specialist in continuing evidence-based practice changes

This is Retrospective cohort analysis study

The level of the study is 3

Patients in the critical care unit

The period of enrolment was 1000 line days.

Value of the clinical nurse specialist (CNS)-led efforts in optimizing the patient outcomes by having a progressive monitoring and the management

The infection rate of the critical care unit patients reduced from 1.5 per 100o line days to 0.

Sandoval, C. (2015). Three practice bundles to reduce CLABSIs

This is a study based on the use of evidence from a single descriptive study.

The level of the evidence is 6

No enrolment period. No patient since it was not a case study or randomize trial study

Central-line insertion bundle

Healthcare acquired infections remain a significant challenge for most of the healthcare facilities. This is due to the CLABSI whose control still remains a problem

Scheithauer, S., Lewalter, K., Schroder, J., Koch, A., Hafner, H., Krizanovic, V., Nowicki, K., Hilgers, R.-D., & Lemmen, S. (2014). Reduction of central venous line-associated bloodstream infection rates by using a chlorhexidine-containing dressing

A randomized controlled trial

Level of evidence is 4

Patients in admission and at risks of acquiring the CLABIS.

The period of enrolment was from November 2010 to May 2012

Reduction of the central venous associated blood stream infection rates through the use of the chlorhexidine-containing dressing.

40 CLABIS occurred in 34 patients leading a significant reduction in the overall CLABIS rate in patients with dress containing chlorhexidine.

Wilder, K. A., Wall, B. Haggard, D. & Epperson, T. (2016). CLABSI Reduction Strategy: A Systematic Central Line Quality Improvement Initiative Integrating Line-Rounding Principles and a Team Approach.

Retrospective cohort analysis study

Level of evidence is 4

Neonatal intensive care patients

The period for the enrolment was 1000 line days

Systematic Central Line Quality Improvement initiative integrating line-rounding principles and the team approach

The CLABIS rate was effectively reduced from 3.9 in 2011 to 0.3 per 1000 line days in 2014. There was an overall improvement of 92 percent

U.S. Department of Health and Human Services. (2011). Health-care-associated infection (HAI)

This is a systematic review study on descriptive and qualitative studies.

The level evidence of this study is 5

Patients are those who are exposed to the healthcare acquired or associated infections

Antibiotic stewardship, making connections, partnering to heal, and improving patient safety

Antibiotic stewardship improves the antibiotic use through optimizing the clinical outcomes and reducing the unintended impacts. Having a focused prevention activities and the improvement of the antibiotic use are synergistic.