Based on documented studies, the incidence of hospital-acquired infections is closely interconnected with the effectiveness of disinfection and pre-procedural preparations. Hospital-acquired infections occur due to infection transmission to the patient’s body during preparation for a certain procedure, using some invasive treatment (central venous catheters), doing preoperative bathing, disinfection, and skin cleansing. It should be mentioned that 7 patients out of 100 in developed and 10 in developing countries are reported to acquire at least one infection while they are in the hospital (World Health Organization, n.d.). Present-day disinfectants do not show a significant impact on the rate of HAIs as it remains high. For this reason, new methods to prevent HAIs must be found. The results of the research show that chlorhexidine gluconate preparations are comparatively effective solutions. This bactericidal ingredient proved to reduce the amount of bacteria that can cause infections. With regard to the issue, chlorhexidine gluconate is proposed to be used in preoperative skin cleansing, daily bathing, and central venous catheters to reduce the rates of morbidity and mortality and decrease healthcare costs.
Keywords: chlorhexidine gluconate, CHG preparations, hospital-acquired infections, surgical-side infections, blood-stream infections, chlorhexidine gluconate bathing
Final Capstone Project
Hospital-acquired infections (HAIs) or nosocomial infections are reported to be the reason for high morbidity and mortality rates. While hospitals are created to take care of the patients’ health, the incidence of infections that are transmitted in the hospital shows that this primary function is often impossible to reach. In this case, healthcare establishments do harm to people. For this reason, the issue of HAIs is burning nowadays and requires close attention of healthcare providers, hospital administration, and researchers.
According to Nguyen (2006), hospital-acquired infections “encompass almost all clinically evident infections that do not originate from patient’s original admitting diagnosis”. They become evident in 48 hours after a patient was hospitalized (Kleinpell, Munro, & Giuliano, 2008, p. 1). HAIs, surgical site infections (SSIs), and bloodstream infections in particular are claimed to affect many patients seriously (Roesler, Halowell, Elias, & Peters, 2010, p. 224). These infections often have fatal outcomes. Moreover, Levin et al. (2011) admit that SSIs cause longer hospitalization and higher healthcare expenses than others do (p. 321).
Surgical site infections are the most frequent subject that is analyzed by scientists. For instance, Lipke and Hyott (2010) claim that 4.5% of all patients who underwent operations acquire some infections in the hospital during the operation (p. 288). There are different reasons for that but the most apparent and frequent ones are inappropriate disinfection and patient’s preparation for surgery. Al Maqbali (2013) admits, “An effective antiseptic skin preparation is vital to reducing the amount of microorganism in the surgical incision. Ultimately, this could help to prevent the SSI from ever occurring” (p. 1227). Nurses, as direct healthcare providers and professionals who assist in operations and prepare patients for such an invasive treatment as surgery, should take care of positive results of disinfection they do. They use different antiseptics to provide necessary patient’s preparation. Providone-iodine and alcohol are used in most cases, though other different antiseptics, for example chlorhexidine gluconate, are not forbidden (Al Maqbali, 2013, p. 1227). As two solutions aforementioned proved to be slightly effective in reducing the incidence of surgical site infections, scientists try to find other bactericidal ingredients that will assist nurses in healthcare they provide and guarantee positive results of their work.
It is a well-known fact that many infections are transmitted through blood. Bloodstream infections refer to hospital-acquired infections as well as surgical site infections. Therefore, they are also under discussion of scholars and healthcare providers. If one considers hospitals, bloodstream infections are mostly catheter-associated. Wu, Crews, Zelen, Wrobel, and Armstrong (2008) claim that pin track infections occur when external fixation is used and are regarded as the most common complication of this procedure (p. 416). Katie Scales (2009) supports this idea. She says that the use of vascular access devices increases the risk of transmitting the infection (Skales, 2009, p. 41). Moreover, the scientist assumes that such a complication is life-threatening. Bacteremia is reported to be most often transmitted via central venous catheters. Along with other infections, bacteremia leads to prolonged hospital care and high healthcare costs (Skales, 2009, p. 41).
Petree, Wright, Sanders, and Killion (2012) provide astonishing statistics on the outcomes of hospital-acquired bloodstream infections. They claim that each year, around 250,000 people are infected in the hospital during some invasive treatment, and 28,000 of them die. In general, bloodstream infections cost between $296 million and $2.3 billion per year. Thus, one infection costs approximately $45. 000 (Petree, Wright, Sanders, & Killion, 2012, p. 532). As the data is comparatively recent, one can assume that bloodstream infections are a serious issue that requires immediate reaction from both scientists and healthcare providers.
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Hospital-acquired infections occur due to bacteria that get into the human organism by different means. Surgical operations and external fixation are not the only possible ways. Patients can be infected through the environment, in which they are staying in the hospital. For this reason, daily bathing and some other disinfecting procedures are important to prevent HAIs. As the rate of infections that affect patients in healthcare establishments has remained almost unchanged over the last decade, one can conclude that the methods of disinfection that are used today are not effective enough. That is why many scholars admit that other means to prevent HAIs should be found. Some propose products that contain chlorhexidine gluconate (CHG) as a new progressive method that can save people’s lives and reduce healthcare costs. For instance, Al Maqbali (2013) claims that chlorhexidine and alcohol skin preparations are more effective than providone-iodine that are now used in most cases (p. 1227). Levin et al. (2011) conducted a study proving that chlorhexidine gluconate was helpful in the prevention of gynecological surgical site infections, while providone-iodine using now turned out to show worse results. Lipke and Hyott (2010) argue that 2% CHG solution to skin preparation is effective in SSIs reduction. Roesler, Halowell, Elias, and Peters (2010) admit that CHG cloths reduce the growth of bacteria for a long time, therefore shortening the incidence of surgical site infections. For this reason, they suggest chlorhexidine gluconate implementation in the disinfecting process as a necessary policy to decrease the rate of HAIs. Other scientists suggest using chlorhexidine gluconate preparations as a means to prevent transmitting infections through the vascular access devices (Scales, 2009; Petree, Wright, Sanders, & Killion, 2012; Wu et al., 2008). For instance, Powers, Peed, Burns, and Ziemba-Davis (2012) proved that CHG significantly decreased bacterial growth and, therefore, made daily patient bathing safer. The reason is that due to a lower amount of bacteria, this chemical substance decreases the possibility of HAIs occurrence (Powers et al., 2012, p. 338). In general, many scientists analyze the issue of hospital-acquired infections, claiming that new methods to fight them should be found. They suggest chlorhexidine gluconate products as a new means to tackle this problem.
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Powers, J., Peed, J., Burns, L., & Ziemba-Davis, M. (2012, September). Chlorhexidine bathing and microbial contamination in patients’ bath basins. American Journal of Critical Care, 21(5), 338-343. doi: http://dx.doi.org/10.4037/ajcc2012242.
Roesler, R., Halowell, C. C., Elias, G., & Peters, J. (2010, February). Chasing zero: Our journey to preventing surgical site infection. AORN Journal, 91(2), 224-235.
Scales, K. (2009, October 28). Correct use of chlorhexidine in intravenous practice. Nursing Standard, 24(8), 41-46.
World Health Organization. (n.d.). Health care-associated infections fact sheet. Retrieved from http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
Wu, S. C., Crews, R. T., Zelen, C., Wrobel, J. S., & Armstrong, D. G. (2008). Use of chlorhexidine-impregnated patch at pin site to reduce local morbidity: The ChIPPS Pilot Trial. International Wound Journal, 5(3), 416-422.