Adding a Chlorhexidine Patch to the IHI Bundle: Goal Zero in Reducing Central Line-Associated Bacteremia

BACKGROUND/OBJECTIVES: The Institute for Healthcare Improvement (IHI) as well as other regional initiatives has outlined evidence-based best practices for improving rates of central line-associated bacteremia (CLAB). Brookdale University MC has since 2000 implemented various interventions, including education, proper hand hygiene, maximal sterile barriers, chlorhexidine skin antisepsis, and optimal site care with a result of reducing CLAB in adult ICUs from 24.8 to 3.1 CLABs per 1000 catheter days. We report on an 8-month study that assessed the effect of adding to the bundle a chlorhexidine impregnated patch on the occurrence of bacteremia. METHODS: Subjects in the study included all patients in 4 adult ICUs (30-beds) who had central lines inserted. Central lines included triple-lumen, dialysis, swan-ganz, and peripherally inserted central lines. CLAB definition used was that as published by the National Nosocomial Infection Study (NNIS) group. Group I patients (n = 277; May 2005-Aug 2005) had bundle interventions as outlined above. Group II patients (n = 226; Sep 2005-Dec 2005) had a chlorhexidine-impregnated patch (Biopatch, Johnson & Johnson, Somerville, NJ) placed at the catheter insertion site. Compliance with the individual components of the protocol was assessed by direct observation of the insertion site. RESULTS: Compliance with the chlorhexidine patch protocol was measured 36 times in the 4 ICUs during the Group II period and rose to the following maximum levels: Patch at catheter site - 98%; blue side on patch placed facing up (100%). CLAB rates were significantly reduced from 3.1 per 1000 catheter days in the Group I period to 0.0 per 1000 catheter days in the Group II period after introduction of a chlorhexidine patch (p ≤ 0.5). No adverse reactions were noted in any patient. Based on a mean cost of $45,254 per CLAB as published by the Centers for Disease Control, the avoided costs for the institution (minus the cost of product) is estimated to be $314,678 per year. CONCLUSIONS: The results of this study suggest that the use of a chlorhexidine patch adds considerably to a CLAB reduction bundle, as well as contributing to reduced infection costs.