Implementing daily chlorhexidine gluconate (CHG) bathing in VA settings: The human factors engineering to prevent resistant organisms (HERO) project

Am J Infect Control, 2021 · DOI: 10.1016/j.ajic.2020.12.012 · Published: June 1, 2021

Simple Explanation

This project aimed to understand how to best put CHG bathing into practice in non-ICU units. Researchers wanted to know the best way to make this happen using a human factors approach. The team examined what made it hard or easy to use CHG in four different Veteran's hospitals. They looked at things like how much time it took, staff worries, and what people thought of the CHG products. The study found that it's important to plan well and have everyone on the team feel responsible for CHG bathing. Staff also need good training and regular checks to make sure they're following the right steps.

Study Duration

Not specified

Participants

4 non-ICUs at 4 distinct VHA facilities

Evidence Level

Case study

Key Findings

1
Barriers to implementing daily CHG bathing include time constraints, concerns about increasing antibiotic resistance, and workflow and product-related issues.
2
Engaging champions and fostering unit shared responsibility are facilitators to daily CHG bathing.
3
Shortfalls were observed in patient education, hand hygiene, and CHG use on tubes and drains during CHG bathing implementation.

Research Summary

This study evaluated the implementation of chlorhexidine gluconate (CHG) bathing in non-intensive care units (ICU) within the Veterans Health Administration (VHA) using a human factors approach. The multiple case study approach included non-ICU units from 4 Veterans Health Administration settings and used focus groups, interviews, observations, and skin CHG concentrations to assess barriers, facilitators, and compliance. The study concluded that well-planned rollouts, a unit culture promoting shared responsibility, staff education, and compliance measurement are key to successful implementation of daily CHG bathing in non-ICUs.

Practical Implications

Mentored Implementation

Utilize a mentored implementation approach for complex interventions to enhance scalability and produce local experts.

Organizational Readiness Assessment

Assess unit and facility readiness prior to implementing CHG bathing, addressing constructs of the Consolidated Framework of Implementation Research.

Champion Engagement

Formally appoint internal leaders or unit champions to influence attitudes, address barriers, and boost confidence among frontline staff.

Study Limitations

1
Interviews and focus groups may have introduced bias due to convenience sampling.
2
Bias may be introduced when RNs and CNAs were being observed during the bathing process.
3
CHG skin swabs were limited at some sites due to distance issues.

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