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.


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


Musuuza, J., Hundt, A.S., Carayon, P., Zimbric, M.L., Schuetz, V., Reppen, M., Smith, W., Koffarnus,K., Brown, R.L., Roberts, T.J., Bowling, J., Jalali, K. and Safdar, N. “Implementing daily chlorhexidine gluconate treatment for the prevention of healthcare-associated infections in non-intensive care settings: A multiple case analysis” To be published in PLOS One, 2020. PMC7182260


Knobloch, M.J., Musuuza, J.S., McKinley, L., Zimbric, M.L., Baubie, K., Atherton, S., Pfund, A., Hagle, M., Rommelfaenger, M., Galea, M., Ferguson, M.R., Matteson, K.J., Dhein, J., Moore, M., Marx, D., Rick, D., Hundt, A.S., Pfeiffer, C.D., Crnich, C.J., Carayon, P., and Safdar, N. “Examining Factors Influencing Implementation of Chlorhexidine Gluconate (CHG) Bathing Treatment in Veterans Health Administration (VHA) Settings: The Human Factors Engineering to Prevent Resistant Organisms (HERO) project” Submitted to Implementation Science Communications, 2019.


Yanke, E., Moriarty, H., Carayon, P. and Safdar, N. “The invisible staff”: a qualitative analysis of environmental service workers’ perceptions of the VA Clostridium difficile prevention bundle using a human factors engineering approach” Accepted for publication in the Journal of Patient Safety, 2018. PMC6800805