A product introduced at Rouge Valley Health System’s (RVHS) two hospital campuses – Rouge Valley Centenary in east Toronto, and Rouge Valley Ajax and Pickering in west Durham Region – is helping to drastically reduce the number of hospital-acquired bacteria.
The RVHS infection control team began looking for ways to combat Vancomycin-Resistant Enterococci (VRE); Methicillin-Resistant Staphylococcus Aureus (MRSA); and Extended Spectrum Beta-Lactamase (ESBL) in units that were more prone to these organisms. Staff were already using a liquid form of two per cent Chlorhexidine Gluconate (CHG), a skin antiseptic that’s highly effective in preventing the spread of these organisms, while reducing secondary transmission to health care workers. Staff would use a basin to mix the CHG with water, however, it wasn’t working as effectively as they had hoped.
“We found that CHG in liquid form mixed with the patient’s bath water did not allow for a consistent application of two percent CHG,” explains Paula Raggiunti, director of infection prevention and control, RVHS. “We thought that there had to be a more effective way to apply it to the patient’s skin.”
“Bath in a Bag”
The team learned of an alternative: wet cloths that contained two per cent CHG. Sometimes called a “bath in a bag”, the packaged wipes are stored in a warmer on the unit, making them warm to the touch when applied on the patient’s skin. Each pack contains six individual wipes soaked in CHG. One pack per day is used for each patient for bathing. One wipe is used for the neck and torso; one for the arms; one for the legs; one for underneath the belly; one for the back; and one for the patient’s buttocks.
“The wipes allow for the consistent application of CHG, from an infection control perspective. It also eliminated the use of basins, which can harbor bacteria. This was a win-win for us,” says Raggiunti.
The cloths were trialed on five different units at both hospital campuses from February to April 2012. This included intensive care, medicine and telemetry units. Staff were trained on how to properly use the wipes, and daily reinforcement on the units helped to ensure proper use.
On average, there were about 24 cases per quarter of VRE, MRSA, EBSL, combined, on the trialed units. By the end of three-month trial, there was an astounding 74.5 per cent drop, down to just 6 cases in total across those units.
Better staff and patient satisfaction
Not only have the wipes helped to improve infection control and drastically reduce the number nosocomial colonizations, both patients and staff are pleased with the product. A survey collected at the end of the trial showed that the majority of the staff liked the CHG wipes, found them easy and effective to use, and that the majority of their patients were also satisfied.
“It’s become such a part of our routine now,” explains Marie Loughnane, clinical practice leader on 9West, one of the medicine units now using the CHG wipes. “It’s really helped to improve things, not just from an infection control perspective, but it has also enhanced the patient experience.”
“I like them. They’re fast, and you can get the job done in just one action. It’s also easy to teach a patient how to use them. They’re always warm when we use them, and our patients appreciate that,” explains registered practical nurse Joyce Cameron, who frequently uses the wipes on her unit at Rouge Valley Centenary.
Maintaining improved results
After the trial, usage of the wipes was expanded to include two additional medicine units at Rouge Valley. Eighteen months after they were introduced in those first five units, there has been a combined 52 per cent reduction in nosocomial colonizations of MRSA, VRE and ESBL. Some individual units have seen a drop by as much as 79 per cent. Infection control continues to meet quarterly with the units, helping to maintain these successful results.