RICHMOND - Say goodbye to soap and water and basin baths in hospital adult intensive-care units as more facilities turn to disposable pre-moistened antiseptic cloths to bathe patients in an effort to reduce infections.
Research in the New England Journal of Medicine last week and a study last year by HCA, the nation's largest hospital chain, are among a growing body of evidence that suggests chlorhexidine washcloths can help reduce hospital-acquired infections in intensive-care unit patients.
"Sometimes they call it a 'bath in a bag' or a basin-less bath," said Dr. Michael W. Climo, lead author of a study out last week titled "Effect of Daily Chlorhexidine Bathing on Hospital-Acquired Infection."
Climo also is hospital epidemiologist at McGuire Veterans Affairs Medical Center in South Richmond.
The cloths are used, then thrown away and patients allowed to air-dry. There is no rinsing. Patients cannot use other products such as lotions that might interfere with the antibacterial effect of the chlorhexidine.
By some estimates, 1.7 million health care-associated infections occur in the U.S. every year, resulting in about 100,000 deaths.
Infections associated with central lines -- those long tubes inserted in a vein in the chest or arm and ending at the heart to carry nutrients and medicine to the body -- are among the most serious and costly, adding an estimated $45,254 per infection to the cost of care.
The study reported last week enrolled 7,727 patients at six intensive-care units or bone marrow transplantation units between August 2007 and February 2009. The study compared bathing with single-use chlorhexidine-containing cloths to disposable washcloths that did not contain an antiseptic.
The research was funded by a cooperative grant from the federal Centers for Disease Control and Prevention and Sage Projects, which makes chlorhexidine washcloths.
"The most significant finding is a significant reduction (in infections) for people who got chlorhexidine washing cloths," Climo said.
The bathing protocol is now part of standard practice at McGuire, Climo said.
Many hospitals have already instituted use of the antiseptic cloths or are in the process of doing so.
Dr. Mike Edmond, hospital epidemiologist at VCU Medical Center, said in a 2010 interview that patients in adult intensive-care units there are bathed with chlorhexidine instead of soap and water.
"We continue to bath all patients in the ICU setting with the chlorhexidine washcloths daily (no basin baths)," Edmond said last week.
"More recently, we have begun to do the same for patients outside of the ICUs," said Edmond, chairman of the division of infectious diseases at the medical center.
HCA, which operates Henrico Doctors' Hospital and CJW Medical Center's Johnston-Willis and Chippenham campuses, among others locally, is moving to the pre-packaged cloths soaked in chlorhexidine.
"We have started the process. We have the policy," said Bonita Allen, a registered nurse and coordinator of infection prevention and control at HCA Virginia's Henrico Doctors' Hospital three campuses.
"We are just getting in the supplies and ready to teach the nurses. It should be in place by March," Allen said of the new adult ICU bathing protocol.
Instructions for using the antiseptic cloths call for following a specific order for washing arms, chest, legs and the rest of the body. The antiseptic cloths are not used on the face.
The study released last week was stopped briefly in 2008 when Sage Products recalled certain lots of chlorhexidine cloths because chlorhexidine solution from an outside supplier was found to contain bacteria. No patients were harmed, according to the company's voluntary recall notice.
Although using the chlorhexidine cloths is an extra expense, some hospital officials believe it will be cost-effective in the long run if infections are prevented.
In addition, it may reduce use of antibiotics.
And "it probably will save lives," Allen said. "Bloodstream infections are almost the worse thing you can get."
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@FORDHealthWonk David, what good to clean the patient and not do a better job of cleaning the area around the patient?
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Gordon W Bettany