KMCSMC Daily CHG Bathing Expansion 1 WHY Chlorhexadine

KMC/SMC Daily CHG Bathing Expansion 1

WHY Chlorhexadine Gluconate (CHG)? • To Reduce Healthcare Associated Infections! • CHG reduces both the number & types of organisms which colonize on the skin • Colonization increases infection risk • Therefore, CHG reduces infection risk Oct 1, 2014 2

CHG Daily Bathing Protocol Using CHG cloths to include: All ICU patients All patients with Central Lines/PICC including Med-Surgical Units All patients with indwelling urinary catheter s (Foley) including Med-Surgical Units All patients on Ventilators including Med-Surgical units/Stepdown 3

AND CHG Daily Bathing Surgical Targets on each Hospital Campuses • KMC SMC CABG Colons Hysterectomy ABD Hysterectomy Fusions/Laminectomies Replacement Total Hip Replacement Total Knee Replacement C-Section Trauma • GVH CABG Colon Hysterectomy ABD Hysterectomy Fusions/Laminectomies Replacement Total Hip Replacement Total Knee Replacement C-Section ABD Total Hip Total Knee Bariatric SVH Colons ABD Total Hip Total Knee C-Section 4

For those campuses using CHG cloth for peri-care: CHG cloths can be used for peri-care to the peri area. An additional package of 2 CHG cloths may be needed to do peri-care. But is not to replace soap & water to clean incontinence, soiling, or body odors in this area. CHG is NEVER to replace the betadine used as a skin prep prior to inserting an indwelling catheter. 5

CHG Bath Cloth Warmer • • • Place packs in Sage warmer Ready Warmers will indicate when cloths are “Ready” for use. . Cloths need approximately 2 hours to warm “Flashing” light indicates wipe will expire in 24 hours-use first Wipes Expire after 84 hours in Warmer-Dispose these READY • Warmer Light will indicate 84 hour time period……. Dispose • Don’t overstock warmer • Only put packs in warmer that are needed for next 24 hours 6

DAILY CHG BATHING PROTOCOL: CHG replaces routine patient bathing for duration of stay Only use CHG wipes below the jawline Apply CHG with firm massage to remove germs CHG cloths are warmed for patient comfort May be used at room temperature (i. e. febrile patient) Inform patient that their skin may feel tacky for 1 - 2 minutes due to the emollients and aloe; this tacky feeling will go away Use only specified SAGE warmer for CHG cloths Do not put cloths in microwave Do not flush used cloths in toilets ! CHG can stain linens – Discard used cloths in trash 7

Confirm Necessity for placement of Central Lines and Foley’s ! Peri-Care: Perform Peri-care prior to Foley insertion • Use minimum of 3 washcloths (sequence of cleaning is very important) • Use soap and water or CHG cloths • With each wash cloth, wipe front to back one time (from perineum to rectum) • Never return the wash cloth to the front and never reuse the wash cloth on another area • Never use a wash cloth from another area to clean the peri area • Dispose of CHG cloths in trash • Place wash cloth in a laundry bag after use; do not place dirty wash cloths on bed linens or room surfaces (e. g. , sink, bed, or countertops) • Document peri-care in EPIC For those campuses using CHG cloth for peri-care: Use CHG cloths for routine peri-care twice a day 8

Confirm Necessity for placement of Central Lines and Foley’s ! INCONTINENCE: • Clean body fluids off with soap and water or hospital approved products • If SOAP is used, rinse off & dry thoroughly • If skin needs Barrier Cream – apply it • After 1 hour apply CHG to involved area if skin does not require other treatment like creams • Dispose of CHG WIPE in Trash. DO NOT FLUSH! • Regardless of compatibility issues, patient’s skin has priority. Address skin issues as indicated by wound care or medical team. Central Lines/PICC/Tubes • Apply CHG right up to dressing/incision area 9

Additional Clinical Points • Patients w/ heavy body odor may need a “soap & water” bath first • Use only hospital approved lotions • CHG can be applied after bath once skin pores have returned to baseline (~1 hour after bath/shower). This helps prevent deeper penetration of CHG into skin layers which may cause skin irritation. 10 • Skin hypersensitivity is RARE. Discontinue use if this occurs.

Documentation of CHG in Medical Record: Doc Flow Sheet - Daily Cares & Safety Flow Sheet Hygiene Section Skin Care Select CHG Bath 11

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