Reduction in patient refusal of CHG bathing.
Date
2023-09
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Abstract
Background
Daily chlorhexidine gluconate (CHG) bathing is a well-supported intervention to reduce patient's risk of central line associated bloodstream infection (CLABSI); however, compliance with this practice is suboptimal. One major barrier is patient refusals of CHG bathing. The purpose of this project was to implement tailored interventions to mitigate this barrier. The specific aims were to reduce patient refusals, increase compliance with CHG bathing, and evaluate CLABSI rates and nursing staff's knowledge of CHG bathing.Methods
Iterative Plan-Do-Study-Act (PDSA) cycles were implemented over the course of 6 months. Run charts were used to identify signals of improvement. Interventions included printed educational flyers for staff and patients, educational sessions, an electronic learning module, and a "badge buddy."Results
We saw a reduction in the median percentage of patient refusals documented, from 23% to 8% after the PDSA cycles. Documentation compliance with CHG bathing increased only slightly from 46% to 47%. CLABSI rates decreased 6% from 0.69 to 0.65.Discussion
Using interventions tailored to the clinical setting can impact patient outcomes. Other health care systems should consider implementing PDSA cycles to improve evidence-based practices.Conclusions
Using PDSA cycles can result in a reduction in patient refusal documentation, and may slightly improve CHG bathing compliance and CLABSI rates.Type
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Destine, Yvette, Kellie Capes and Staci S Reynolds (2023). Reduction in patient refusal of CHG bathing. American journal of infection control, 51(9). pp. 1034–1037. 10.1016/j.ajic.2023.01.007 Retrieved from https://hdl.handle.net/10161/29558.
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Staci Reynolds
Dr. Staci Reynolds joined Duke in January 2016. At DUSON, Dr. Reynolds teaches in the ABSN Program (neuroscience nursing) and DNP program (healthcare quality improvement methods). Previously, she clinically served as a Clinical Nurse Specialist (CNS) at DUH within the neuroscience inpatient units and Infection Prevention and Hospital Epidemiology department. In January 2023, Dr. Reynolds was appointed the Editor-in-Chief of the Journal of Nursing Care Quality. Before coming to DUSON, she was a neurocritical care nurse and a neuroscience CNS at Indiana University Health Methodist Hospital.
Dr. Reynolds received a baccalaureate degree in nursing science from Indiana University (IU) in Indianapolis, Indiana. She earned a Master’s degree as a Clinical Nurse Specialist at IU in 2011, and completed her PhD at IU in May 2016. Dr. Reynolds’ dissertation focused on implementation of clinical practice guidelines, and her current research interests includes evidence-based practice implementation and quality improvement.
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