Chlorhexidine Gluconate Bathing—A Patient Perspective

Chlorhexidine gluconate bathing is a critical infection prevention component in patient care. Its use goes beyond presurgical measures as a way of preventing surgical site infections; it is also a measure to clean the patient and decrease microbial burden. Adherence to chlorhexidine gluconate’s proper use can bring a mixed bag of staff and patient challenges. As such, investigators on a recent study sought to address some of the challenges to using chlorhexidine gluconate and what patient or health care-worker practices might result in noncompliance.

Investigators evaluated the issues through a survey of 437 patients within an 865-bed academic medical center. Patients with a length of stay longer than 2 days were interviewed regarding their bathing practices, chlorhexidine gluconate bathing compliance, and their perceptions of bathing during their hospital stay. Only patients who volunteered and were alert/oriented partook in the survey.

Over the course of 24 days, the investigators utilized the electronic medical record (EMR) system to evaluate documentation of bathing. During this EMR review, the team found that of the 437 patients, 74% had documentation of a bath within the last day, while 75% of the patients communicated that they had received a bath within that time. This finding indicates that documentation within the EMR of bathing practices can be considerably accurate for surveillance and quality metrics.

Next, the investigators evaluated the education patients received on chlorhexidine gluconate bathing. A total of 136 patients recalled receiving education on chlorhexidine gluconate bathing, while 215 did not. Of those who recalled being educated, 35% reported correct chlorhexidine gluconate use during the most recent bath, while 36% reported that nonhospital-provided soap or lotion was used. Of those patients who did not recall receiving education on chlorhexidine gluconate bathing, 42% used nonhospital-provided soap or lotion, 27% used a basin to bathe, and 33% had a chlorhexidine gluconate bath.

Further comparison of chlorhexidine gluconate bathing practice and EMR documentation was evaluated between self-care and assisted patients.

“Patients assisted by hospital staff for their bath were less likely to use nonhospital-approved bathing products (14% vs 30%, P = .001) and had an overall higher daily bathing self-reported compliance (87% vs 77%, P = .03) than self-care patients,” study authors wrote.

Moreover, those patients assisted with bathing tended to have more accurate documentation of their bath, versus those patients who did self-care bathing, which is not surprising.

Overall, the investigators found that when patients were able to recall education on chlorhexidine gluconate bathing, their compliance significantly improved. This is particularly interesting as there was not a standardized patient chlorhexidine gluconate bathing education tool available for health care workers. Sadly, a small number of patients were able to communicate the correct chlorhexidine gluconate bathing process, which supports the need for a standardized education strategy for both staff and patients.

This study is particularly helpful in that it focuses on patients not in intensive care units and ultimately reveals a breakdown of knowledge and communication regarding chlorhexidine gluconate bathing. The investigators underscored that the low frequency of patient reporting of correct use in chlorhexidine gluconate bathing products further emphasizes a critical need for patient-focused education efforts. Chlorhexidine gluconate bathing plays a large role in infection prevention practices and patient buy-in is an important aspect of ensuring compliance.