Major Article
You get back what you give: Decreased hospital infections with improvement in CHG bathing, a mathematical modeling and cost analysis

https://doi.org/10.1016/j.ajic.2019.07.003Get rights and content

Highlights

  • HAIs are reduced with improvement in chlorhexidine bathing.

  • Spending money on chlorhexidine wipes results in savings.

  • More money is saved as the efficiency of chlorhexidine bathing is increased.

Background

Multiple studies have shown that bathing with chlorhexidine gluconate (CHG) wipes reduces hospital-acquired infections (HAIs). We employed a mathematical model to assess the impact of CHG patient bathing on central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and hospital-onset Clostridium difficile (C diff) infections and the associated costs.

Methods

Using a Markov chain, we examined the effect of CHG bathing compliance on HAI outcomes and the associated costs. Using estimates from 2 different studies on CHG bathing effectiveness for CLABSI, CAUTI, and C diff, the number of HAIs per year were estimated along with associated costs. The simulations were conducted, assuming CHG bathing at varying compliance rates.

Results

At 32% reduction in HAI incidence, increasing CHG bathing compliance from 60% to 90% results in 20 averted infections and $815,301.75 saved cost.

Conclusions

As CHG bathing compliance increases, yearly HAIs decrease, and the overall cost associated with the HAIs also decreases.

Section snippets

Model structure

A discrete-time Markov Chain was developed to model the movement of individuals between different patient states. These states include: Ni, newly admitted patients who have not yet received a CHG bath in i days (i=0,1,2), Pi,  patients whose most recent CHG bath was i days ago (i=0,1,2,3), and patients with an HAI, PI. We define the state vector X(n)=[N0(n),N1(n),N2(n),P0(n),P1(n),P2(n),P3(n),PI(n)]T to be the number of patients in each state at day n.

The distribution of patients on any given

RESULTS

As the CHG bathing compliance rate increases, the number of yearly HAIs decreases and the overall health care–associated costs decrease (Fig 2). Increasing the CHG bathing compliance from 60% to 90% incurs an additional cost of $106,291.65 spent on CHG bathing wipes. However, at 32% reduction in HAI incidence, increasing the compliance rate from 60% to 90% results in 20 averted infections and $815,301.75 saved cost. Further, based on the HAI mortality rate of 15%-25%,13 approximately 5 lives

DISCUSSION

We employed a Markov chain to study the reduction of HAIs and the associated costs of HAIs by varying the CHG bathing compliance rate. Previous literature2, 3,8, 9, 10 support the use of CHG bathing as a preventative and cost-saving practice. Our results show how the effectiveness of CHG bathing impacts the overall return of health care savings. Our results are based off an 850 patient medical center with an incidence rate of 1.025 cases per 1,000 patient days for all HAIs. The infection

CONCLUSIONS

Using a mathematical model to understand CHG bathing compliance is novel. This model allows for predicting consequences of varying compliance rates without experimentation that would be unethical. Mathematical models are based on assumptions made. Here, daily deviations from the parameters were not accounted for, although we assumed that over the course of 1 year that the daily deviations would not be significant. Although the recently reported ABATE trial14 did not find that CHG use in non-ICU

References (14)

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Cited by (16)

  • Reduction in patient refusal of CHG bathing

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    2021, American Journal of Infection Control
    Citation Excerpt :

    As daily CHG bathing can significantly decrease CLABSI risk, it is imperative that it is completed consistently and correctly. Indeed, Reagan and colleagues7 found that increasing compliance with CHG bathing can result in a 32% reduction in hospital-acquired infection incidence. To that end, we must identify feasible and effective ways to measure CHG bathing compliance.

  • Catheter-associated urinary tract infection

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    Specific recommendations are detailed in Table 4. Studies on the impact of hydrophilic catheters [44], chlorhexidine baths [94–97] and nurse-driven catheter management protocols [98] remain small and not strong enough for generalized recommendations. Further studies into the utility, efficacy and cost-effectiveness of these preventive strategies, as well as other novel diagnostic stewardship [99] [–] [101] and surveillance measures are needed [102–104].

  • Chlorhexidine bathing to prevent healthcare-associated vancomycin-resistant Enterococcus infections: A cluster quasi-experimental controlled study at intensive care units

    2021, Journal of the Formosan Medical Association
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    Unlike a targeted approach, a universal decolonization strategy will not be affected by false-negative screening results or delay in reporting, and therefore, is preferred at ICUs.30 CHG bath (using 2% CHG-impregnated paper towel) costs NT$160 (US$5.3, at an exchange rate of 30.0 NT$/US$, provided by PBF Biotech, Taiwan, for this study) per patient-day, but will averts expensive treatment cost for VRE-HAI (daptomycin or linezolid, and prolonged hospitalization) when VRE infections occur.31 Further study on the cost-effectiveness of 2% CHG in Taiwan is warranted.

  • Is it cost effective to use a 2% chlorhexidine wipes bath to reduce central-line associated blood stream infection? A quasi-experimental study

    2021, Brazilian Journal of Infectious Diseases
    Citation Excerpt :

    Previous studies also support the use of CHG bathing as a cost-saving practice. Reagan et al. demonstrated by mathematical models how the effectiveness of CHG bathing impacts the overall return of health care savings.12 However, there have been report showing that bathing with CHG is effective in reducing infection by Gram positive cocci but there is still no consensus regarding Gram negative bacilli.13

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Conflicts of interest: None to report.

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