Infection Control: Use of Chlorhexidine Washcloths to Prevent Nosocomial Infections

This research activity evaluates the effectiveness of chlorhexidine washcloths in preventing hospital acquired infections. It compares the effects of proposed intervention with traditional infection control methods. The research question is 'Does use of chlorhexidine washcloths reduce nosocomial infections?'

Running head: EVIDENCE BASED NURSING RESEARCH
Topic 1- Infection Control
Name of the Student
Name of the University
Author Note

1EVIDENCE BASED NURSING RESEARCH
Introduction- Infection control refers to the discipline that is concerned with management
and prevention healthcare associated or nosocomial infections in hospital settings. It is an
essential topic in nursing owing to the fact that it forms the foundation of healthcare services,
which aims to improve health and wellbeing of all patients. Infection control is selected as the
research topic due to the fact that it is imperative to public health practice (Krein et al. 2012). Its
forms the major component of all kinds of invasive procedures that are administered upon
patients in healthcare settings. Thus, infection control has two major implications in nursing
practice (Rosenthal et al. 2012). While environmental disinfection will help in effectively
controlling outbreak of an epidemic, it will also prevent spread of the infection by identifying
exposure of all patients and healthcare staff to contagious infection. Further benefit is associated
with the fact that the practice will remain in good standing with the standards and codes of
nursing practice and will also help in increasing awareness on maintaining hygiene (Tacconelli et
al. 2014).
Reasons for undertaking research- The research activity has been undertaken on the
aforementioned topic of infection control due to the fact that it is the primary objective of nurses
in preventing the spread of pathogens such as, bacteria and viruses. It is essential in order to
maintain a safe hospital environment for all patients. Reducing the risk of spread of pathogens
will help in lowering rates of hospital acquired infections and will also ensure delivery of
appropriate nursing practices. In addition, most sick and disabled people are cared for at
hospitals in confined spaces. This increases their likelihood of getting affected with several
microorganisms (CDC 2012). Therefore, it is essential to control the spread of infections.
Furthermore, the research will also help in strengthening and increasing my awareness on
demonstration of adequate nursing standards, thereby enhancing my clinical expertise and

2EVIDENCE BASED NURSING RESEARCH
improving professional development. The research will also help in comparing the effectiveness
of traditional use of soap and water with chlorhexidine impregnated washcloths, thereby
facilitating an easy understanding of the infection control practice that should be implemented in
nursing practice (Rosenthal et al. 2013). It will also help in improving the nursing competencies
through an exhaustive analysis of relevant literature, thereby assisting nursing workflow.
Research question/hypothesis- The research question on which this research activity will
be conducted is as follows:
Does use of chlorhexidine washcloths reduce nosocomial infections?
This research question will act as answerable inquiry that will facilitate addressing
specific issue related to infection control in hospital patients.
Research objective- It aims to evaluate the effectiveness of bathing using chlorhexidine
washcloths in preventing hospital acquired infections. It will also compare the effects of
proposed intervention with traditional infection control methods. This will further assist
healthcare professionals such as, nursing staff in implementing the findings in future practice,
thereby lowering rates of infection and improving the overall health and wellbeing of clients.
Another discipline that can be correlated to this research activity is patient safety. This
discipline emphasizes on safety of patients in healthcare settings through adoption of appropriate
prevention strategies that are formulated with the aim of reducing medical errors (Borer et al.
2012). Thus, patient safety helps in eliminating chances of adverse patient outcomes. It
encompasses reporting and analysis of all kinds of errors that might violate patient rights and
predispose them to health hazards. Thus, in addition to nursing, the research activity will also
enhance the arena of patient safety.

3EVIDENCE BASED NURSING RESEARCH
Sources- Two sources that will be utilized to gather information on relevant articles related to
infection control are as follows:
 PubMed- https://www.ncbi.nlm.nih.gov/pubmed/
 Cochrane Library- http://www.cochranelibrary.com/
Methods of gathering information- Information will be gathered by searching relevant
articles from the aforementioned sources. The research question is kept comprehensive and
specific. The study will focus on using specific key terms or search terms that will help in
retrieving articles that are relevant to the research question. Key search terms such as, “infection
control”, “infection prevention”, “hygiene”, “hospital infection”, “nosocomial”, “chlorhexidine”,
“washcloth” will be used in combination with several boolean operators namely, AND, OR, and
NOT. Use of these operators will help in excluding articles that have been unpublished or are not
relevant to the topic of interest.
Systematic reviews will be used to collect information on use of chlorhexidine due to the fact
that they contain exhaustive analysis of a wide range of studies and help in formulating answers
to the proposed question in a structured format. Using systematic reviews in place of any other
method will help in sysnthesising all available evidences on the particular question and will help
us determine how effective the proposed intervention is.
Systematic approach- Huang et al. (2016) conducted a systematic review that aimed to
investigate effectiveness of daily chlorhexidine bathing in preventing nosocomial infections
among ICU patients. Owing to the fact that healthcare associated infections are found to increase
the length of hospitalization among critically ill patients and also increase associated medical
costs, selection of this systematic review was a correct approach in retrieving information. It

4EVIDENCE BASED NURSING RESEARCH
included articles extracted from EMBASE, PubMed, and the Cochrane Central Register of
Controlled Trials. It included 3 RCTs and 12 quasi-experimental studies, the primary outcomes
of which were associated with rates of catheter linked bloodstream infections, urinary tract
infections, and pneumonia. Results from most articles included in the review indicated that use
of chlorhexidine in daily bathing helped in significantly reducing HAI among patients. Daily
bathing in CHG was also found to lower mortality rates and occurrence of adverse events.
A randomized control trial conducted by Climo et al. (2013) evaluated the effectiveness of
daily bathing using CHG impregnated washcloths on incidence of hospital infections and drug
resistant organism acquisition. On conducting the trial among patient across 6 ICUs, findings of
the trial showed a significant reduction in infection acquisition and rates of MRSA and VRE. A
significant decrease was also observed in bloodstream associated infections during the
intervention period.
A quasi-experimental study was conducted among 3 cohorts to determine the effect of
hospital wide CHG bathing on nosocomial infections. Upon administration of CHG bathing in
form of showers or bed basin bath, the rate of HAI was monitored. Findings suggested that
adherence to CHG bathing was more in adult patients in ICU. Furthermore, a significant
decrease was observed in the infection rates during the intervention period, which was succeeded
by increase in the washout period. Thus, implementation of chlorhexidine did not show any
adverse effects on patient health. Analysis of the survey responses suggested that most nurses
were capable of successfully implementing standardized bathing protocol (Rupp et al. 2012).
A before-and-after study was conducted to describe the impact of CHG impregnated
washcloths on VRE colonization. The study involved administration of the intervention on

5EVIDENCE BASED NURSING RESEARCH
patients in the hematology and oncology ward and the incidence of VRE was determined.
Significant decrease was observed in the rate of VRE acquisition during intervention, on
comparison with baseline period. Roommates of patients with such infections were found at an
increased risk of acquiring such infections (Bass et al. 2013).
The systematic review is particularly relevant for this research activity due to the fact that it
will facilitate understanding of the safety of chlorhexidine treatment, through an exhaustive
analysis of the included research articles. It will also provide more generalizability of the
findings and will help in implementation of the findings in actual practice.
Comparison- Comparison of the aforementioned RCT and cohort study is given in Appendix.
Conclusion- Thus, it can be concluded that hospital acquired infections occur due to
prevalence of bacterial, viral and fungal pathogens. These infections are most commonly found
in intensive care units where patients are being treated for serious, life-threatening diseases.
Based on the findings of the articles analysed, it can be stated that use of chlorhexidine
washcloths can be implemented by infection control nurses in order to promote antisepsis. It will
also prevent bacterial colonization, thereby eliminating infection. Thus, it has broad clinical
application in healthcare setting and can be used as an effective and safe skin-prepping agent.
Impact- In order to reduce transmission of infection among critically ill patients, the nurses
should put on gloves and masks for protection (Page et al. 2013). They should take precautionary
steps for washing their skin after handling CHG. Eyes of the patients as well as nurses should be
rinsed cautiously on contact with CHG (Loveday et al. 2014).
Use- The collected information can be used in workplace by showing compliance to specific
guidelines framed by the hospital authorities. Patients will be regularly monitored to identify

6EVIDENCE BASED NURSING RESEARCH
those susceptible to infection and will be isolated before administration of CHG. It will also help
in identifying the source of infection or colonization of pathogens. Thus, it can help in reducing
rates of nosocomial infections in workplace (Barbier et al. 2013).
Reflection- The research helped me search realize that infection control is a major priority
for all healthcare professionals. I understood that it is the duty of all nursing staff to ensure that
healthcare professionals should practice good infection control practices to prevent all kinds of
risk factors that might increase infection rates. Thus, all employees in contact with patients are
bound to adhere to infection control practices for preventing the spread of organisms. One major
change is regular monitoring of all patients and immediately isolating the ones found at an
increased risk of infection.
Issues- There is a need to conduct further research on effectiveness of other washcloths
impregnated with herbal agents such as, bamboo for preventing infection (Yasin, Liu and Yao
2013). This will help patients who are cared for at their homes, where there is less availability of
chlorhexidine washcloths.

7EVIDENCE BASED NURSING RESEARCH
References
Barbier, F., Andremont, A., Wolff, M. and Bouadma, L., 2013. Hospital-acquired pneumonia
and ventilator-associated pneumonia: recent advances in epidemiology and
management. Current opinion in pulmonary medicine, 19(3), pp.216-228.
Bass, P., Karki, S., Rhodes, D., Gonelli, S., Land, G., Watson, K., Spelman, D., Harrington, G.,
Kennon, J. and Cheng, A.C., 2013. Impact of chlorhexidine-impregnated washcloths on reducing
incidence of vancomycin-resistant enterococci colonization in hematology–oncology
patients. American journal of infection control, 41(4), pp.345-348.
Borer, A., Saidel-Odes, L., Eskira, S., Nativ, R., Riesenberg, K., Livshiz-Riven, I., Schlaeffer, F.,
Sherf, M. and Peled, N., 2012. Risk factors for developing clinical infection with carbapenem-
resistant Klebsiella pneumoniae in hospital patients initially only colonized with carbapenem-
resistant K pneumoniae. American journal of infection control, 40(5), pp.421-425.
Centers for Disease Control and Prevention., 2012. Vital signs: preventing Clostridium difficile
infections. MMWR. Morbidity and mortality weekly report, 61(9), p.157.
Climo, M.W., Yokoe, D.S., Warren, D.K., Perl, T.M., Bolon, M., Herwaldt, L.A., Weinstein,
R.A., Sepkowitz, K.A., Jernigan, J.A., Sanogo, K. and Wong, E.S., 2013. Effect of daily
chlorhexidine bathing on hospital-acquired infection. New England Journal of Medicine, 368(6),
pp.533-542.
Huang, H.P., Chen, B., Wang, H.Y. and He, M., 2016. The efficacy of daily chlorhexidine
bathing for preventing healthcare-associated infections in adult intensive care units. The Korean
journal of internal medicine, 31(6), p.1159.

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Krein, S.L., Kowalski, C.P., Hofer, T.P. and Saint, S., 2012. Preventing hospital-acquired
infections: a national survey of practices reported by US hospitals in 2005 and 2009. Journal of
general internal medicine, 27(7), pp.773-779.
Loveday, H.P., Wilson, J., Pratt, R.J., Golsorkhi, M., Tingle, A., Bak, A., Browne, J., Prieto, J.
and Wilcox, M., 2014. epic3: national evidence-based guidelines for preventing healthcare-
associated infections in NHS hospitals in England. Journal of Hospital Infection, 86, pp.S1-S70.
Page, K., Graves, N., Halton, K. and Barnett, A.G., 2013. Humans,‘things’ and space: costing
hospital infection control interventions. Journal of Hospital Infection, 84(3), pp.200-205.
Rosenthal, V.D., Bijie, H., Maki, D.G., Mehta, Y., Apisarnthanarak, A., Medeiros, E.A.,
Leblebicioglu, H., Fisher, D., Álvarez-Moreno, C., Khader, I.A. and Martínez, M.D.R.G., 2012.
International Nosocomial Infection Control Consortium (INICC) report, data summary of 36
countries, for 2004-2009. American journal of infection control, 40(5), pp.396-407.
Rosenthal, V.D., Richtmann, R., Singh, S., Apisarnthanarak, A., Kübler, A., Viet-Hung, N.,
Ramírez-Wong, F.M., Portillo-Gallo, J.H., Toscani, J., Gikas, A. and Dueñas, L., 2013. Surgical
site infections, International Nosocomial Infection Control Consortium (INICC) report, data
summary of 30 countries, 2005–2010. Infection Control & Hospital Epidemiology, 34(6),
pp.597-604.
Rupp, M.E., Cavalieri, R.J., Lyden, E., Kucera, J., Martin, M., Fitzgerald, T., Tyner, K.,
Anderson, J.R. and VanSchooneveld, T.C., 2012. Effect of hospital-wide chlorhexidine patient
bathing on healthcare-associated infections. Infection Control & Hospital Epidemiology, 33(11),
pp.1094-1100.

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Tacconelli, E., Cataldo, M.A., Dancer, S.J., Angelis, G., Falcone, M., Frank, U., Kahlmeter, G.,
Pan, A., Petrosillo, N., Rodríguez‐Baño, J. and Singh, N., 2014. ESCMID guidelines for the
management of the infection control measures to reduce transmission of multidrug‐resistant
Gram‐negative bacteria in hospitalized patients. Clinical Microbiology and Infection, 20(s1),
pp.1-55.
Yasin, S., Liu, L. and Yao, J., 2013. Biosynthesis of silver nanoparticles by bamboo leaves
extract and their antimicrobial activity. J Fiber Bioeng Inform, 6(6), pp.77-84.

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Appendix
Article 1- Climo, M.W.,
Yokoe, D.S., Warren, D.K.,
Perl, T.M., Bolon, M.,
Herwaldt, L.A., Weinstein,
R.A., Sepkowitz, K.A.,
Jernigan, J.A., Sanogo, K. and
Wong, E.S., 2013. Effect of
daily chlorhexidine bathing on
hospital-acquired
infection. New England
Journal of Medicine, 368(6),
pp.533-542.
Article 2- Rupp, M.E.,
Cavalieri, R.J., Lyden, E.,
Kucera, J., Martin, M.,
Fitzgerald, T., Tyner, K.,
Anderson, J.R. and
VanSchooneveld, T.C., 2012.
Effect of hospital-wide
chlorhexidine patient bathing
on healthcare-associated
infections. Infection Control &
Hospital
Epidemiology, 33(11),
pp.1094-1100.
Currency 2013 2012
Study findings Overall MDRO acquisition
rates was 5.10 case per 1000
patients administered with
CHG, compared to 6.60 cases
among patients subjected to
non-antimicrobial washing.
Rates of HAIs were 28%
Significant lowering in
infection during intervention
period upon administration of
CHG baths.

11EVIDENCE BASED NURSING RESEARCH
lower on use of CHG
washcloths.
Strength of study No major skin reactions or
adverse effects were observed.
Results supported previous
findings on trials that
promoted use of CHG for
reducing infection
transmission.
No adverse effects were
reported by patients and CHG
bathing was well tolerated
Relevance to objectives Daily bathing using CHG
washcloths showed significant
reduction in MRDO
acquisition, which was the
main goal of the study
Daily bathing in CHG reduced
rates of healthcare-associated
infections
Reliability It supports previous findings
that use of CHG cloths will
prevent BSI risk among
critically ill patients. Since it
recruited participants from
different geographic regions,
similar findings will be
obtained on repeated trials
The cohorts helped in
reproducibility measure of
findings and the dose response
could be assessed. Similar
findings can be expected in
future trials.
Validity It carried a robust examination CHG bathing was related to

12EVIDENCE BASED NURSING RESEARCH
of the interaction of CHG
bathing with infection rates. It
showed unanticipated low
rates in CLABSI-associated
fungemia
reduction in CGI rates,
showing consistency with
previous studies
Benefits It was the first multicentered,
randomized clustered trial.
CHG bathing proved to be a
good horizontal infection
prevention strategy and did
not create any serious adverse
effects on patients
Risks At times allergic reactions
may arise with the topical
application of CHG
Rate of infection and
colonization might have
increased during washing
period
Feasibility associated with
information
2% no rinse CHG washcloths
can be easily administered
upon patients in the workplace
Bed basing baths with CHG
can be readily implemented in
the real time setting
Conclusion Daily CHG bathing
significantly reduces risk of
HABSI and MDRO
acquisition
CHG bathing can be used to
prevent central-line associated
bloodstream infection