University of Wisconsin–Madison

Implementation of Chlorhexidine Bathing to Reduce Healthcare-Associated Infections – The I-Care study

  • Overview:  Healthcare-associated infections (HAIs) remain a frequent but preventable complication for hospitalized patients. HAIs are considered largely preventable, and a patient safety issue. There is a critical need for implementation research to facilitate translation of evidence into practice. One intervention that has proven to be effective is daily chlorhexidine gluconate (CHG) treatment for hospitalized patients. Numerous studies have found a reduction in blood stream infections, and colonization by multidrug resistant organisms with a daily CHG treatment. This project will evaluate the process of implementing a daily CHG intervention using the Systems Engineering Initiative for Patient Safety (SEIPS) in four non-ICU nursing units of three facilities. This study focuses on implementing CHG treatment; however, this project will also provide a framework to implement and evaluate other evidence-based interventions for HAI prevention. Regardless of the results, the proposed study will generate data, tools and methods with wide-spread applicability for HAI prevention.

    Aims:

    1. To use a systems engineering approach (SEIPS) to implement a daily CHG bathing intervention in the non-ICU Medical-surgical units of a community hospital, rural hospital and teaching hospital.

    2a. The implementation of the daily chlorhexidine intervention including assessment of barriers and facilitators using a multiple case study approach will be evaluated by the research team.

    2b. To evaluate the fidelity to the daily CHG intervention using direct observations, CHG usage, EHR documentation and microbiologic assessment (skin swabs).

    3. The third and final aim of this study is to explore the impact of daily CHG intervention on hospital-acquired infections.

    Funding: Agency for Healthcare Research and Quality (AHRQ)

  • Nasia Safdar, MD, PhD
    Associate Professor, Department of Medicine – Infectious Disease
    Associate Chief of Staff for Research and Staff physician, William S. Middleton VA Medical Center
    University of Wisconsin-Madison

    Roger Brown, PhD
    Professor, School of Nursing
    Director, Research Design Methodology and Statistics Unit
    University of Wisconsin-Madison

    Pascale Carayon, PhD
    Procter & Gamble Bascom Professor in Total Quality
    Department of Industrial and Systems Engineering
    Director, Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Ann Schoofs Hundt, PhD
    Research Scientist, Associate Director of Education
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Jackson Musuuza, MD, MPH, MS
    Research Health Scientist, William S. Middleton Memorial Veterans Hospital, Madison, WI
    Research Assistant, Division of Infectious Disease,
    Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin – Madison
    PhD Candidate, Clinical Investigation

    Shelly Zimbric
    Research Specialist
    Department of Medicine – Infectious Disease
    University of Wisconsin – Madison

    Michelle Schmitz, BS, CIC
    Department of Medicine – Infectious Disease
    University of Wisconsin – Madison

  • Publications forthcoming…

  • Observation Manual for CHG Intervention

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