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Abstract
The following literature review discusses the impact of CHG wipes on rate of CAUTIs in
post surgical patients. A sum of six articles are reviewed and discussed. The main objective of
each article is to evaluate the effects of CHG on CAUTIs. It is important to realize the effect of
CAUTIs on patient cost and quality of care. Since 2008, hospitals do not receive reimbursement
from Medicare for healthcare-associated infections such as CAUTIs, which cost $150 to $450
million each year (Strouse, 2015). Starting in 2015, healthcare facilities that continue to
experience CAUTIs will be penalized through Medicare payment reductions. CAUTIs can
prolong a hospital stay or negatively impact the prognosis of a patient. It has been associated
with 13,000 deaths each year (Strouse, 2015). It is within a health care provider’s best interest to
ensure beneficence with every patient. Reducing the rates of CAUTIs in post surgical patients
would reduce the number of hospital days and complications. This will further impact overall
costs related to CAUTIs and improve quality of patient care. Currently, there is no evidence
based practice for preventing CAUTIs. The purpose of literature review is to evaluate the
current information of CAUTIs, recommend an appropriate course of action to, and overall
Introduction
CAUTIs are catheter-associated urinary tract infections. In urinary tract infections, the
bladder, ureters, and the kidneys are affected. Traditional hygiene practices involve a basin,
soap, and warm water. In other facilities, CHG, or chlorhexidine gluconate wipes, are
used. CHG wipes are antiseptic and antimicrobial in nature and are used in certain facilities in
place of soap and water. The purpose of this literature review is to explore whether the use of
CHG wipes during baths in post-surgical patients decrease the rate of CAUTIs compared to
CHG did not significantly lower the rate of CAUTIs in adult surgical populations
(Strouse, 2015). The benefits of using CHG in comparison to water and soap was related to a
decreased of bacterial population in the basin baths. When used with other methods in a
“bundled” approach, CHG usage was found to lower CAUTI rate. However, it is impossible to
isolate the the CHG itself in isolation within the bundle. The limitations of the study included a
small sample size. A smaller sample size may skew conclusion/results (Strouse, 2015).
CHG baths did not reduce high - level bacteriuria, but significant differences were found
in high - level candiduria among men (Rupp, 2016). Generally, no differences were found in
low level bacteriuria. Major differences were associated with decolonization in men. The
differences. Limitations of the study included the general number of studies separate from this
that had found no significant effects of CHG usage on CAUTI. The most relevant indicator of
CAUTI, symptoms of UTIs, was not measured. Lastly, potential variables and changes in
The next article to be discussed explores the effect of chlorhexidine bathing on hospital-
Machan, 2011). The limitations of the study were determined to be the low event rate, lack of
concurrent control group, no VRE screening compliance data, non-blinding by nursing and
infection control staff, and lack of bathing compliance data. The results of the experiment shows
that daily bathing with CHG wipes led to decreased rates of MRSA and VRE HAIs, which
shows that CHG wipes may be effective in preventing other infections in patients.
Another article assesses nursing interventions that are effective in reducing CAUTIs
(Oman, Makic, Fink, Schraeder, Hulett, Keech, Wald, 2012). Limitations include the risk for
confounding factors related to CAUTI rates due to the study being uncontrolled, the low amount
of present CAUTIs on the studied units, and the fact that the study only provides a brief glimpse
of the effectiveness of the interventions, rather than long term-effectiveness. It was found that
reinforcing evidence-based protocols and nursing interventions were effective in reducing the
rate of CAUTIs.
A randomized controlled crossover study that took place in an adult ICU in Nashville,
Tennessee, used a sample size of 9340 persons, comparing the use of CHG wipes to traditional
soap and water. There was no significant difference in the use of CHG wipes vs soap and water
in the incidence rate of CAUTIs (Noto, 2015). There was found to be a possibility of bias in the
A meta-analysis made up of multiple already published studies was done. The studies
to 15 studies were examined among adult intensive care units. Similar to the article described
above, the was no double-blinded method used, which could have caused bias. Only 3 of the
THE EFFECTS OF CHG WIPES ON CAUTI INFECTION RATES 5
trials were randomized controlled trials. There seems to be a significant difference in decreased
rate of CAUTIs when using CHG wipes over soap and water ( Huang, Chen, Wang, & He,
2016).
Conclusions
Overall, results were mixed on whether or not the usage of CHG wipes during routine
baths truly decrease the incidence of CAUTIs. In a study on general medical patients, it was
shown that the use of CHG is effective in reducing rates of MRSA and VRE, although no data
was presented on the effect on CAUTIs specifically. Another study showed that an effective
catheter care.
Recommendations
CAUTIs. There is not enough evidence to conclude significant factors of CHG on CAUTIs.
Reinforcing current evidence-based practices regarding catheter care is shown to decrease the
rate of CAUTIs. It is important as nurses to evaluate the necessity of foley catheters in patients
and to ensure that they are not used for excessive amounts of time, as this puts patients at higher
risk for infection. Due to the mixed results of this literature review, there is a need for more
research on how CHG wipes affect the rate of CAUTIs. Lack of standardized methods
THE EFFECTS OF CHG WIPES ON CAUTI INFECTION RATES 6
References
Huang, H., Chen, B., Wang, H., & He, M. (2016, November). The efficacy of daily chlorhexidine
bathing for preventing healthcare-associated infections in adult intensive care units. The Korean
Kassakian, S., Mermel, L., Jefferson, J., Parenteau, S., & Machan, J. (2011). Impact of chlorhexidine
bathing on hospital-acquired infections among general medical patients. Infection Control and
Noto, M. J. (2015, January 27). Chlorhexidine Bathing and Infections. Journal of American Medicine,
313(4):369-378. doi:10.1001/jama.2014.18400
Oman, K. S., Makic, M. B. F., Fink, R., Schraeder, N., Hulett, T., Keech, T., & Wald, H. (2012). Nurse-
Rupp, M. E. (2016). Do chlorhexidine patient baths prevent catheter-associated urinary tract infections.
Strouse, A. C. (2015). Appraising the literature on bathing practices and catheter - associated urinary
816X.2015.35.1.11