Decolonization of

on-ICU Patients With Devices N

Section 14-1 – Addressing Questions Asked by Staff:

Chlorhexidine for Bathing

Why does the hospital use special soap for bathing and showering in patients

with medical devices?

This hospital is dedicated to improving medical care for our patients. Bacteria commonly found

body. The Active Bathing to Eliminate (ABATE) Infection Trial, a national study in 53 hospitals,

found that use of CHG antiseptic soap for bathing or showering led to a 37 percent reduction in

positive methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant

enterococcus (VRE) clinical cultures and a 32 percent reduction in all-cause bloodstream

infections in patients with specific medical devices.

Which patients with devices should receive a CHG bath?

Based on the findings from the ABATE Infection Trial, use CHG baths for patients with the

following medical devices is recommended:

• Central venous catheters (including dialysis catheters and port-a-caths)

• Midline catheters

wish to have this done, it is their right to refuse, but most patients accept if they understand

that the bath prevents infection. Patients will need encouragement to take their daily bath.

Staff enthusiasm is critical to protect patients with bathing. Refer to “Talking Points for

Chlorhexidine Bathing” in this section on how to address common reasons for patient refusals.

The nursing protocols provide details on escalation pathways for addressing patient refusals.

If the patient is stating that this is not the best time for a bath, then the staff member should

encourage the patient to take a bath at a later time. Remind the patient that the bath only

takes 5–10 minutes, and that the bath will help protect them from germs.

soiled, they should be changed.

Is CHG safe to use on the perineum?

Yes, CHG is safe to use on the perineum, including the female labia and genital surface. Over 1

million CHG baths have been given in clinical trials with the direct instruction to clean the male

and female perineum well.

Are there special instructions for large or obese patients?

Yes. In order to be effective at removing germs, it is important that CHG cloths be applied with

a firm massage on all skin areas (gently massaged onto wounds). This is particularly important

in skin folds of large or obese patients since dirt, sweat, and germs can accumulate there. Make

sure that after the CHG cloth is applied, the skin fold areas are allowed to fully dry. Lift skin

drain closest to the body with a clean portion of a CHG cloth or a new cloth. Nonabsorbable

(non-gauze) dressings should also be wiped with a clean portion of the CHG cloth or a new cloth

after the skin is cleaned. If devices are wrapped for showering, be sure to clean them after

showering. Unwrap the devices and use a clean CHG cloth to clean the device and over the

When we use CHG bathing for patients with central lines and midline catheters,

if my patient also has a urinary catheter, should the urinary catheter be cleaned

with CHG as well?

Yes. For any patient selected to receive a CHG bath based on our hospital’s criteria, it is

important that you clean the 6 inches of ALL of their devices, lines, tubes, and drains closest to

the patient read the instructions will save you time later because the patient will become

familiar with the bathing or showering process. Then, prior to the bath or shower, verbally

repeat the cloth bathing or showering instructions to ensure proper CHG application. Remind

the patient that if the bathing or showering is not performed correctly, they may not receive

the protective benefits.

If the patient wishes to perform a bed bath, remember to show the patient how to open the

CHG cloth packages since they can be difficult to open from the ends. Remind them to massage

the CHG onto their skin and over non-absorbent dressings. Help them clean hard-to-reach areas

and clean the 6 inches of all lines, tubes, or drains closest to the body.

If the patient is able to step into the shower, 4% CHG liquid soap along with a mesh sponge or

The sticky feeling is due to the moisturizing ingredients in the CHG cloths and will go away as it

dries.

Is it true that CHG cloths can stain sheets?

When CHG comes into contact with bleach during the laundry cycle, a chemical interaction can

occur and produce a brown stain. To avoid this, avoid placing CHG cloths directly on sheets.

Once applied to skin, CHG will bind to skin proteins and will not stain sheets.

I am having trouble applying bandages after bathing my patients with CHG.

Does CHG weaken bandage adhesive?

If you are having trouble reapplying a bandage after bathing a patient with CHG, it’s usually

because not enough time has elapsed for drying. After bathing a patient, allow the CHG to dry

for about 5 minutes, which should be enough time for the CHG to absorb and not affect the

after soiling, or any other reasons for additional cleaning such as freshening up. Do not use

soap to clean incontinent patients because soap can inactivate CHG. First remove urine/stool

with usual incontinence wipes or cloths and water. Next, clean with CHG and allow to air dry.

Be especially thorough if there are any nearby wounds, pressure ulcers, or breaks in the skin.

Finally, apply CHG- compatible barrier protection over the area. Repeat as often as needed

throughout the day.

What are the most commonly missed bathing practices that need

reinforcement?

cleaning over non-absorbable dressings

Thus far, despite broad CHG use in most hospitals, CHG resistance has rarely been reported in

the United States.

I think my patient may be having a reaction to the CHG cloths or CHG liquid

soap. What should I do?

Any questions regarding issues related to the decolonization products should be directed to the

patient’s nurses and treating physicians. Severe allergic reactions to CHG are extremely rare.

However, if you think a patient may be developing a severe allergic reaction (including hives,