Infection Control and Hospital Epidemiology

This assignment delves into the world of infection control and hospital epidemiology. It presents a comprehensive analysis of various studies and articles on the topic, including the effects of chlorhexidine patient bathing on healthcare-associated infections. The assignment also examines the relevance of daily bathing in chlorhexidine to reducing healthcare-associated infection rates and multidrug-resistant organism (MDRO) acquisition. It highlights the importance of infection control practices in hospitals and the need for robust strategies to prevent hospital-acquired infections.

Running head: RESEARCH TOPIC 1
Infection Control
Name of the Student
Name of the University
Author Note

1RESEARCH TOPIC 1
Executive summary
Infection control refers to the discipline that is concerned with prevention of healthcare-
associated or nosocomial infections. It refers to a practical sub-discipline related to several
aspects of epidemiology. Altough under-supported or under-recognized, it forms an essential part
of healthcare infrastructure. Hospital epidemiology and infection control are imperative to public
healthcare practice, and are most often followed within the confines of pre-selected healthcare
delivery settings. Infection control also addresses the underlying factors, which are associated to
the spread of severe infections within healthcare settings from patients to staff, other patients,
and family members. Therefore, appropriate prevention of infection control encompasses
strategies related to hand hygiene or hand washing, disinfection, sterilization, surveillance, and
vaccination. The report will contain an exhaustive analysis of articles that have provided
evidence for the effectiveness of use of chlorhexidine gluconate impregnated washcloths in
preventing nosocomial infections.

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Table of Contents
Introduction- Planning the research activity....................................................................................3
Discussion........................................................................................................................................4
Reasons for undertaking research................................................................................................4
Research question/hypothesis......................................................................................................4
Research objective.......................................................................................................................5
Other discipline............................................................................................................................5
Sources of data and evidence.......................................................................................................6
Search strategy.............................................................................................................................6
Systematic approach....................................................................................................................6
Distinction between relevant and irrelevant information............................................................8
Prioritising information...............................................................................................................8
Comparison..................................................................................................................................9
Conclusion.......................................................................................................................................9
Impact of findings......................................................................................................................10
Use of information in workplace...............................................................................................10
Reflection...................................................................................................................................10
Issues that require further research and evaluation....................................................................11
References......................................................................................................................................12
Appendix........................................................................................................................................14

3RESEARCH TOPIC 1
Introduction- Planning the research activity
Infection control and prevention with the use of chlorhexidine washcloths
The discipline of infection control often encompasses prevention and management of
nosocomial and healthcare associated infections in healthcare facilities. This topic is of utmost
importance to nurses as it forms the basis of delivery of healthcare services and works towards
improving the overall health and wellbeing of all patients. Infection control is imperative for
public health practice. Two major implications of this topic are associated with their
effectiveness in controlling an epidemic outbreak, and preventing an infection spread by
recognising all underlying factors and routes of exposure to communicable diseases (Tacconelli
et al. 2014).
Nurses are placed at an unique position for bringing about changes that help them to
improve care standards. There are several tools made available to nurses for creating a safe
environment for their patients. The nursing duty requires them to adapt certain precautions that
form the cornerstone of a safe health-based environment that is free of infection. Thus, infection
control and prevention is a major duty of nursing practice. This research activity will enable
nurses to understand the significance of maintaining appropriate infection control practices in the
healthcare setting.

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Discussion
Reasons for undertaking research
Preventing or controlling the spread of pathogens, such as, viruses and bacteria is the
primary duty of nurses. Thus, the research activity is essential for maintaining a safe healthcare
environment for all healthcare professionals, patients, and their family members. Most disabled
and ill people are cared for in confined spaces. This makes them more susceptible to acquiring
all forms of HAIs (Rosenthal et al. 2013). Thus, the research will increase an awareness on the
nursing standards needed to control infection and will also help in determining effectiveness of
the intervention (use of chlorhexidine washcloths) for the same.
Research question/hypothesis
Question: Does chlorhexidine bathing reduce rates of hospital acquired infections among
patients?
Hypothesis: Using chlorhexidine washcloths on patients admitted to the ICU will help in
reducing rates of infection in the hospital setting.
In recent years, several efforts have been taken to increase the awareness and knowledge of
healthcare professionals for eliminating potential mortality and morbidity associated with
hospital acquired infections (HAIs). In addition, several countries have taken rigid stance for
averting such infections. According to the researches that have been conducted on determining
impact of chlorhexidine bathing washcloths, CHG has been found to reduce rates of central line
associated infections, UTI, ventilator-associated pneumonia, and SSI. Trials that compared rates
of infection, before and after use of CHG washcloths have shown significant lowering in the
infection rates after CHG institution (Krein et al. 2012). Furthermore, evidences have also

5RESEARCH TOPIC 1
indicated that CHG results in a decrease in vancomycin resistant Enterococci. Primary BSI rates
of infection have also demonstrated significant reduction with the use of CHG (CDC 2012).
 Nursing Interventions: The intervention would be that the nurse should bath all patients
admitted to the ICU with the use of 2% CHG washcloths, in place of regular soap and
water.
 Client perceptions: Studies have shown nurses who adopt appropriate infection control
techniques are better able to prevent spread of infections in the ICU from patients to their
family members or healthcare professionals. In addition to hand hygiene maintenance,
use of CHG has also been established effective in reducing spread of nosocomial
infections in healthcare settings. Thus, use of this intervention will also make the clients
or patients learn and understand that the concerned healthcare professionals are taking all
possible efforts to improve their health outcomes.
 Political Issues: Increased healthcare costs, lack of nursing staff, turnover rates
Research objective
The objective of this research activity is to evaluate or investigate the effectiveness or
positive impacts of bathing critically ill patients using 2% chlorhexidine impregnated washcloths
in preventing the incidence of hospital-acquired infections.
Other discipline
Patient safety discipline can also be correlated with the research activity as it illustrates
that safeguarding patients is of utmost importance and can be achieved by adopting essential
prevention strategies that help in lowering rates of medical errors. Hence, patient safety

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eliminates adverse health outcomes. Hence, in addition to assisting the nursing discipline, the
research activity will also enhance patient safety arena.
Sources of data and evidence
 Cochrane Library- http://www.cochranelibrary.com/
 PubMed- https://www.ncbi.nlm.nih.gov/pubmed/
The aforementioned two sources were used to retrieve articles for the research activity as it
contained relevant and current articles that had been published on the effects of chlorhexidine
washcloth use in infection prevention.
Search strategy
Recent and relevant findings were extracted from google scholar with regards to CHG
use as an infection control practice. The research question was kept comprehensive and specific.
Data extraction contained use of several search terms that helped in retrieving relevant articles.
The search terms were “hygiene”, “infection control”, “hospital infection”, “infection
prevention”, “chlorhexidine”, “nosocomial”, “washcloth”. Boolean operators such as, OR, AND,
and NOT were used. This helped in excluding unpublished or irrelevant articles.
Systematic approach
Statement of objective: Use of 2% chlorhexidine gluconate impregnated washcloths by
nurses, for patients admitted to intensive care units will effectively reduce rates of nosocomial
infection in the healthcare setting.

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Data collection: Peer reviewed articles, systematic reviews were used for collecting
relevant, updated and recent research articles that had been conducted for determining
effectiveness of daily 2% chlorhexidine gluconate baths. The first piece of research collected is a
randomised controlled trial. Another cohort study has also been collected as a major piece of
evidence.
Data evaluation: The first piece of research to be evaluated is an RCT that discussed
effects of daily CHG bathing on MDRO acquisition and incidence of bloodstream infections in a
hospital. The RCT was an useful piece of evidence as it helped in determining the direct impacts
of CHG washcloth bathing on patients, thereby showing their effects on HAI rates. It also
demonstrated significant effects of the intervention on rates of associated VRE and MRSA in the
healthcare setting (Climo et al. 2013).
The cohort study was also useful in the sense that it directly evaluated effects of
chlorhexidine patient bathing conducted across a hospital on rates of healthcare-associated
infections. The information from the article can be used for the research activity as, in addition to
effects of the intervention on infection rates, it also demonstrated CHG tolerance among patients
(Rupp et al. 2012).
A systematic review was also considered for the same that investigated effectiveness of
daily CHG bathing in nosocomial infection prevention among ICU patients. Inclusion of this
systematic review was a correct step for this research activity as it contained essential
information pertaining to impact of CHG bathing from 12 quasi-experimental studies and 3
RCTs. It helped in providing relevant information on rates of urinary tract infection, catheter
related infections and pneumonia (Huang et al. 2016).

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A before-and-after study was also used as a piece of evidence that described the direct
impacts of 2% CHG impregnated washcloth use on VRE colonisation. Inclusion of the study was
essential for the research activity as it contained exhaustive information on CHG administration
upon patients admitted to the oncology and hematology ward and also determined the subsequent
rates of VRE (Bass et al. 2013).
Analysis: Overall, from the wide list of articles that were retrieved from the two sources,
the aforementioned four articles were found to be most appropriate for gaining a sound
understanding of the direct influence or impact of bathing ICU patients with washcloths that are
impregnated with 2% chlorhexidine gluconate, in reducing infection rates.
Distinction between relevant and irrelevant information
The systematic review conducted for evaluating the effects of daily bathing of patients
using chlorhexidine washcloths for preventing hospital-acquired infections. Due to the fact that
such infections are found to increase hospitalisation rates, and associated healthcare costs,
information presented in this systematic review was particularly useful and relevant in this
context. In this nursing profession that considers nurses as the frontline of patient-centered care,
dependency of patients on the nursing staff is increasing significantly. Thus, nurses often fail to
provide the adequate level of care that is required for all patients. Therefore, this systematic
review will act as a relevant piece of information and will help nursing professionals to increase
their knowledge on best infection control practices.
Prioritising information
The two research articles are the following:
1. Effect of daily chlorhexidine bathing on hospital-acquired infection.

9RESEARCH TOPIC 1
2. Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections.
Comparison
The comparison for the two articles are given in the appendix.
Conclusion
Thus, it can be conclude from the research findings extracted for this activity that
infection control nurses specialise in preventing or reducing spread of potentially infectious
agents, such as, bacteria and viruses. Therefore, it is imperative to the duty of an infection
control nurse to prevent dangerous epidemics. Some of the most common precautions adopted by
healthcare professionals for infection control include hand washing techniques, use of sanitiser
sprays, and proper bathing of the admitted patients. It can be concluded from the findings that
infection control nurses are expected to use chlorhexidine washcloths while bathing their patients
for preventing spread of germs to healthy individuals and for skin disinfection. Evidences
suggest that chlorhexidine impregnated washcloths when used on the skin are able in reducing
pathogen levels on the skin. Findings also suggest that CHG bathing effectively prevents
pathogen colonisation and subsequent infection, thereby lowering rates of their dissemination to
the environment and to the hands of other healthcare personnel, patients or family members.
Similar findings are also reported by other studies that state that CHG is a safe and effective
antiseptic solution that has broad acting antiseptic activity. Thus, novel uses of chlorhexidine
impregnated cloths will effectively preventing infection.
Therefore, providing nurses with the opportunity of possessing essential nursing skills
that focus on infection control will help in enhancing patient health outcomes, thereby fostering a
healthy nurse-patient relationship, increasing job satisfaction and staff retention.

10RESEARCH TOPIC 1
Impact of findings
It is now considered an imperative nursing duty to maintain standard precautions that
underpin routine adherence to safe nursing practices for preventing spread of pathogens in a
healthcare facility. Nurses should assess the extent of contact with contaminated objects, body
fluids, blood and pathogen, and should comply with essential infection control practices in the
healthcare setting for identifying all patients who are at an increased likelihood of acquiring
nosocomial infections. Showing accurate adherence to the nursing infection control strategies
that includes use of CHG washcloths will help the nurses to interpret their concerns for the
patients and the former will be able to better aniticipate the preferences and demands of the
patients. This will directly improve patient health outcomes and enhance job satisfaction.
Use of information in workplace
The steps of using 2% CHG impregnated washcloths and their benefits can be
disseminated in the workplace (healthcare setting) by creating illustrative posters or pamphlets
that will contain relevant information on the same. It will improve knowledge and skills of the
staff in the area of infection control and prevention, and will also provide a concise idea of the
steps that need to be taken for limiting infection rates.
Reflection
One way that can be implemented in current practice is conduction of weekly meetings
and discussions that will focus on informing all healthcare personnel of their infection control
priorities and cleaning standards that must be followed in the healthcare organisation. It will
make the healthcare professionals conscious and they will be able to meet the necessary health
guidelines. All healthcare workers, in addition to the management will also gain a sound
understanding of their responsibilities in relation to infection control.

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Issues that require further research and evaluation
Further research should be conducted on determining effectiveness of skin wipes or
washcloths that are impregnated with herbal extracts for preventing spread of pathogens. This
will act as an essential step in preventing infection among home-bound patients or those living in
regions with no access to CHG washcloths.

12RESEARCH TOPIC 1
References
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.
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.
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.
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

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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.
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.

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Appendix
Article 1 – 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.
Article 2 - 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.
Currency 2012 2013
Study
findings
Significant reduction in infection
during the intervention period upon
implementation of CHG baths.
Reduced rates of MDRO acquisition in
intervention group compared to control
Strength of
study
No adverse effects reported No major skin infections

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Relevance
to
objectives
Daily bathing in CHG was found to
reduce healthcare-associated
infection rates
CHG daily bathing reduced MRDO rates
Reliability Cohorts facilitated reproducibility
of the research findings and helped
in assessing dose response.
Previous findings were supported by
these results
Validity Showed consistency with previous
findings regarding reduction in
infection rates
Robust examination of CHG bathing
interaction with infection rates conducted
Benefits CHG bathing was a good
horizontal infection prevention
strategy
First multicentered, randomized
clustered trial
Risks Washing period might have
increased infection and
colonisation rates
CHG topical application might lead to
allergic reactions
Feasibility
associated
with
informatio
n
CHG bed basing baths can be
readily implemented
2% no rinse CHG washcloths can be
used in workplace