Use of Chlorhexidine to Prevent Healthcare Associated Infections Peer Reviewed Journal

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In the U.S healthcare environment, the clinical practice guidelines are the effective healthcare protocol to enhance patient’s safety as well as achieving evidence-based practice. The clinical guidelines provide recommendations to the best available practice to assist clinicians and other healthcare professionals to deliver best and quality care. More importantly, the clinical practice guidelines are designed to optimize patients’ care using the systematic assessment and evidence based review to assess pros and cons of the alternative care options. The guidelines serve as the strongest resources to assist the healthcare professionals to make clinical decisions as well as incorporating evidence gained through practice and scientific investigations into patient practice.  Healthcare organizations develop the guidelines in form and policies, which are endorsed across the organization to create a platform that employees will follow and holding employees accountable to achieve a standard of care.  



Clabsi Hospital is one of the best healthcare organizations the United States that adheres to the practice guideline in their clinical practice implementing the antimicrobial administration during surgery to prevent the SSIs (Surgical site infections) and HAIs (healthcare associated infections). I worked with Clabsi Hospital as a nursing professional attached to the general surgery unit. Over the years, I have the pleasure to work at the surgery unit, and my year of experiences with the hospital makes me understand that our surgery unit places highest emphasis  on the prevention of HAIs during the surgery operations. I was part of the team to participate in the HAIs program  to prevent the HAIs and  adhere to the health quality for the unit.  Moreover, our hospital has obtained different certifications for the prevention of infection controls. For example, I have been part of the team whose my organization sponsors to secure the “Certification in Infection Prevention and Control.” (CBIC, 2016 p 1).   

“The certification provides standardized measurement of current basic knowledge needed for our physicians to  practice infection prevention and control. The certification also Encourage our  clinicians to  grow, thereby promoting their professionalism among infection prevention and control professionals.” (CBIC, 2016 p 1).   



Thus, I can personally confirm that Clabsi Hospital places the highest emphasis on the infection prevention and control during the surgery operations that assists our organization adhering to the quality of healthcare standards.



Thus, it is my pleasure to affirm that application of policies is very critical to our surgery unit.  The hospital promotes the training and teaching programs to ensure that all employees adhere to the policy of preventing the HAIs in the surgery units. In the unit, the clinicians are obliged to use the CHG (Chlorhexidine gluconate) before the surgery is carried out to prevent healthcare associated infections. Since there is an evidence-based approach that confirms that Chlorhexidine is a topical antiseptic agent that can reduce the bacterial colonization of skin and is effective against different multidrug-resistant organisms. Thus, our unit’s unit places emphasizes in using the Chlorhexidine gluconate at pre-and post-operative since Chlorhexidine is effective in preventing different types of HRI (health related infections) and the SSIs (Surgical site infections). (Rauber, et al 2013).



Franco, et al (2017) identifies the SSIs (Surgical site infections) as the common phenomenon within the healthcare environment. In the United States, between 2% and 5% of patients who undergo the surgery are affected despite that 55% of the SSIs are preventable with the aid of the evidence-base clinical approaches.  In the United States, the annual total costs of SSIs are estimated between $166 million and $345 million.  While many recommendations have been proposed to prevent the HIAs or SSIs in the United States that include hair removal, use of prophylaxis antibiotic, and the presence of comorbidities, however, the main source of infection is the microorganisms introduced during the surgical procedures.  Thus, our surgical unit is taking every measures to prevent the spread of SSIs using the Chlorhexidine agent.

USE OF CHLORHEXIDINE TO PREVENT HIAs



The HAIs is a major safety concern for both the patients and our providers.  Considering an increase in the mortality, morbidity as well as increased length of stay because of the SSIs and HAIs within the U.S healthcare environment, our healthcare organization has taken measures to prevent the spread of the HIAs during the clinical surgery to enhance the safety of patients and healthcare providers. Thus, we enlist the use Chlorhexidine bathing in the clinical guidelines, which the clinicians must follow when carrying the patient surgery.

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We place emphasis on the hygiene of patients before carrying out the surgery operation. We implement the Chlorhexidine bathing for patients to prevent the event of contamination during the surgery operations. We place emphasize in preventing the HAIs because  HAIs are the multi-resistance bacteria that increase the morbidity, mortality, longer stay in the hospital, and leading to an increase in the costs of care. (Karki, & Cheng, 2012). A colonization of bacteria resistance often increases the risks of infection among inpatients. Thus, we place emphasizes in chlorhexidine gluconate because a whole-body bathing with water soaked with CHG is an effective approach to reducing bacteria density on patient’s skin. Moreover, the method assists in reducing the risks of transmission of bacteria from one patient to the other. Typically, the CHG is effective with “regular cleansing of patient’s skin in intensive care units, hematology-oncology units, or prior to high-risk surgical procedures instead of, or after, the normal soap-and-water bathing.” Karki, & Cheng, 2012 p 72). Moreover, the CHG consists of the antimicrobial agent that is effective against bacteria and has been a successful skin antiseptics since the 1970s. Thus,  out physicians are to follow the guidelines using the CHG to remove HIAs from patients during the operation.

Professional Roles 



The CDC (Center for Disease Control) identifies healthcare-associated infections as the kind of infections that patients receive while receiving medical treatments within the healthcare settings, and yet often preventable. Although, the United States healthcare system has made a significant progress in preventing the HAIs (Healthcare Associated Infections), however, there is much work to be done because there is at least one HIA recorded out of   25 in-patients.  The data presented by the “Center for Disease Control” reveal that there is no change in the “catheter-associated urinary tract infections (CAUTI) between 2009 and 2014.” (CDC, 2016 p 1). In 2011, there was estimated 722,000 HAIs that occurred in the U.S hospitals. Moreover, 75,000 patients died because of the HIAs in the same year. At the global level, hundreds of millions of patients are affected with HIAs each year. Out of 100 hospitals evaluated, 10 in the developing countries and 7 in the developed countries are estimated acquiring the HIAs each year. Steps can be employed to prevent the HIAs by 70%, however, it will involve the participation of all healthcare professionals to make the prevention realizable. Chlorhexidine showering has been identified as the effective preoperative measure to prevent HIAs.

The CDC guidelines for the prevention of HAIs are as follows:

* To mandate healthcare organizations to implement effective infection prevention practice to enhance quality improvement

* Use of antimicrobial agent before and after carrying out the surgery operation to prevent the spread of HIAs and SSIs. 

Thus, the clinicians in our unit use the proactive method to enhance clinical practice by using the Chlorhexidine solution to clean the patient before carrying out the surgery operation. The clinicians are following this guideline because Chlorhexidine is a topical antiseptic agent that is effective in reducing the bacterial colonization of skin and having effective against different multidrug-resistant organisms. The Chlorhexidine is also effective in preventing different types of HRI (health related infections) beside the SSIs.  A pre-surgery showering with the Chlorhexidine will prevent the nosocomial bloodstream infections that happen within the intensive care units.

USE OF CHLORHEXIDINE TO PREVENT HIAs



CLINICAL GUIDELINE FOR USE OF CHLORHEXIDINE TO PREVENT HIAs

Before our team of clinicians start a surgery operation, they follow the evidence-based guideline to ascertain the prevention of HIAs or SSIs within the health care unit.  At pre-operative units, our surgical team uses the chlorhexidine gluconate (CHG) to clean the patient to disrupt the bacterial cell membrane that is present on the body of the patients. Essentially, the CHG has gained popularity because of its effectiveness as showering antiseptic and hand scrubbing prior to surgery. Before touching the patient, the clinicians use the Chlorhexidine solution to wash their hand to protect them from contacting the harmful germs. The physicians use the same solution to clean the patients to protect them against germs, which include the patients’ germs. Our teams also use the fluid agent to protect themselves from contacting harmful patient’s germs.….....

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Reference 

CDC (2016). Healthcare-associated Infections Data and Statistics. Centers for Disease Control and Prevention. Retrieved  01 May 2017 from https://www.cdc.gov/hai/surveillance/ 

Chlebicki, M. P., Safdar, N., O’Horo, J. C., & Maki, D. G. (2013). Preoperative chlorhexidine shower or bath for prevention of surgical site infection: A meta-analysis. American Journal of Infection Control, 41(2), 167-173. doi:10.1016/j.ajic.2012.02.014

CBIC, (2016). Certification. Certification Board of Infection Control and Epidemiology. Retrieved May 4 2017 from https://www.cbic.org/certification 

Edmiston, C. E., Bruden, B., Rucinski, M. C., Henen, C., Graham, M. B., & Lewis, B. L. (2013). Reducing the risk of surgical site infections: Does chlorhexidine gluconate provide a risk reduction benefit? American Journal of Infection Control, 41(5). doi:10.1016/j.ajic.2012.10.030

Franco, L. M., Cota, G. F., Pinto, T. S., & Ercole, F. F. (2017). Preoperative bathing of the surgical site with chlorhexidine for infection prevention: Systematic review with meta-analysis. American Journal of Infection Control, 45(4), 343-349. doi:10.1016/j.ajic.2016.12.003

Karki, S., & Cheng, A. (2012). Impact of non-rinse skin cleansing with chlorhexidine gluconate on prevention of healthcare-associated infections and colonization with multi-resistant organisms: a systematic review. Journal of Hospital Infection, 82(2), 71-84. 

Mehta, Y., Gupta, A., Todi, S. et al. (2014). Guidelines for prevention of hospital acquired infections. Indian Journal of Critical Care Medicine, 18(3), 149. doi:10.4103/0972-5229.128705.

Rauber, J. D., Carneiro, M., Krummenauer, E. C., Machado, J. A., & Valim, A. R. (2013). Preoperative chlorhexidine baths/showers: For or against? American Journal of Infection Control, 41(12), 1301. doi:10.1016/j.ajic.2013.05.007

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