Abstract

CHG-based hygiene methods are often a component of daily hygiene bundles to prevent central line-associated blood stream infections (CLABSIs) in pediatric hematology-oncology patients; however, adherence with 2% CHG wipes was inconsistent within our institution, risking infection for immunocompromised patients. A new 4% CHG foam method offers an alternative and is applied while bathing, as opposed to wipes used 1 h after bathing. An initial cohort of 24 high-risk oncology and bone marrow transplant (BMT) patients agreed to use 4% CHG foam in place of wipes, and then answered surveys to describe their experiences. Ninety-two percent preferred foam over wipes and were more likely to use the foam moving forward. CHG foam was then made available as an option to all patients in need of central line care upon admission to the hospital. Hygiene bundles in the electronic medical record were reviewed to measure baseline adherence rates. Random audits by nursing administration prospectively assessed CHG adherence. CLABSI data were collected prospectively with routine quality metric reports. Results were analyzed using run charts and u-charts, respectively. Hematology-Oncology unit adherence rates remained at a higher rate of adherence, and BMT unit adherence rates increased from an average of 55%–81.6% (p < 0.001). Primary CLABSIs remained rare events (average <1/1000 CVL days). On cost analysis, utilizing CHG foam results in an annual savings estimate of $40,000 for a 24-bed unit. In conclusion, 4% CHG foam provides a cost-effective and patient-preferred option for daily hygiene that maintains CLABSI preventative efforts.

摘要

基于 CHG 的卫生方法通常是日常卫生包的一个组成部分，用于预防儿科血液肿瘤患者的中心线相关血流感染 (CLABSIs)；然而，我们机构内部对 2% CHG 湿巾的依从性不一致，免疫功能低下的患者有感染的风险。一种新的 4% CHG 泡沫方法提供了一种替代方法，可以在沐浴时使用，而不是在沐浴 1 小时后使用湿巾。24 名高风险肿瘤和骨髓移植 (BMT) 患者的初始队列同意使用 4% CHG 泡沫代替湿巾，然后回答调查以描述他们的体验。92% 的人更喜欢泡沫而不是湿巾，并且更有可能继续使用泡沫。CHG 泡沫随后作为一种选择提供给所有入院时需要中心线护理的患者。审查电子病历中的卫生包以衡量基线依从率。护理管理部门的随机审计前瞻性地评估了 CHG 的依从性。CLABSI 数据是通过常规质量指标报告前瞻性收集的。分别使用运行图和 u 图分析结果。血液肿瘤科依从率保持在较高的依从率，BMT 单位依从率从平均 55%–81.6% 上升（p  < 0.001）。主要 CLABSI 仍然是罕见事件（平均 <1/1000 CVL 天数）。在成本分析中，使用 CHG 泡沫可为 24 个床位的单元估计每年可节省 40,000 美元。总之，4% CHG 泡沫提供了一种具有成本效益且患者首选的日常卫生选择，可维持 CLABSI 预防工作。