Background: Daily bathing with chlorhexidine gluconate (CHG) of intensive care unit (ICU) patients has been shown to\nreduce healthcare-associated infections and colonization by multidrug resistant organisms. The objective of this project\nwas to describe the process of daily CHG bathing and identify the barriers and facilitators that can influence its successful\nadoption and sustainability in an ICU of a Veterans Administration Hospital.\nMethods: We conducted 26 semi-structured interviews with a convenience sample of 4 nurse managers (NMs), 13\nregistered nurses (RNs) and 9 health care technicians (HCTs) working in the ICU. We used qualitative content analysis to\ncode and analyze the data. Dedoose software was used to facilitate data management and coding. Trustworthiness and\nscientific integrity of the data were ensured by having two authors corroborate the coding process, conducting member\nchecks and keeping an audit trail of all the decisions made.\nResults: Duration of the interviews was 15 to 39 min (average = 26 min). Five steps of bathing were identified: 1)\ndecision to give a bath; 2) ability to give a bath; 3) decision about which soap to use; 4) delegation of a bath; and 5)\ngetting assistance to do a bath. The bathing process resulted in one of the following three outcomes: 1) complete\nbath; 2) interrupted bath; and 3) bath not done. The outcome was influenced by a combination of barriers and\nfacilitators at each step. Most barriers were related to perceived workload, patient factors, and scheduling. Facilitators\nwere mainly organizational factors such as the policy of daily CHG bathing, the consistent supply of CHG soap, and\nsupport such as reminders to conduct CHG baths by nurse managers.\nConclusions: Patient bathing in ICUs is a complex process that can be hindered and interrupted by numerous factors.\nThe decision to use CHG soap for bathing was only one of 5 steps of bathing and was largely influenced by scheduling/\nworkload and patient factors such as clinical stability, hypersensitivity to CHG, patient refusal, presence of IV lines and\ngeneral hygiene. Interventions that address the organizational, provider, and patient barriers to bathing could improve\nadherence to a daily CHG bathing protocol.
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