Purpose: The purpose of this patient hygiene initiative was to improve organizational compliance with the patient hygiene bundle (bathing, linen change, and oral care) to 90%, with an overall goal to positively impact patient quality outcomes and the patient experience, and decrease never events.
Significance: Evidence-based care suggests that the use of care bundles can decrease negative outcomes related to care (Solutions for Patient Safety, 2014). Studies also show that transformational leadership is important and conducive to empowering nurses and fostering high quality care and outcomes (Boamah, 2018). Successful patient hygiene and bundle compliance translates evidence-based strategies into meaningful and effective solutions that leverage a collaborative nursing culture to optimize organizational performance and patient outcomes. Daily chlorhexidine bathing has been associated with a decreased risk of acquiring CLABSI (Kim et al., 2016), and patient hygiene compliance with this practice is fundamental to the prevention of hospital acquired conditions that impact positive patient outcomes and safety.
Implementation: In FY17 we observed annual hygiene compliance at 45%. To address this, a multidisciplinary workgroup was created to analyze patient hygiene compliance across the system and develop a robust structure and processes to ensure compliance. The nursing leaders on the unit used the transformational leadership style to empower staff to identify the challenges to compliance and offer solutions for correction. The team met monthly to develop and implement a policy and procedures, discuss barriers to successful compliance, and collaborate on an implementation and sustainment plan. A REDcap survey of the bundle elements was created to obtain baseline data at both the unit and organizational levels. To provide awareness and accountability, unit nursing leaders completed chart audits in REDcap and provided the baseline data to the hygiene workgroup who implemented strategies to educate staff, patients and families on the importance of hygiene and its impact on their health. Central line bundle educational flyers were also created in English and Spanish for patients and families, and bathing language for patients with central lines was changed from chlorhexidine bathing to chlorhexidine treatments to emphasis the treatment’s importance. To ignite creativity and competitiveness, units participated in hygiene contests (judged by Infection Control and hospital executives) to demonstrate their knowledge and commitment to achieving compliance.
Evaluation: We received positive feedback from patients and families on the bathing signage. Staff continued to emphasize the importance of the chlorhexidine “treatments” and held each other accountable for ensuring that bathing was completed and documented. The organizational hygiene bundle compliance goal was set at 90% based on SPS recommendations. At the end of FY18, organizational hygiene bundle compliance increased from 45% the previous year to 88% in FY18. Performance for FY19 to date is 91%.
Implications for Practice: Chlorhexidine has demonstrated a reduction in CLABSI, especially those CLABSI colonized with gram-positive bacteria (Resendez et al., 2014). The implementation of this multidisciplinary team has proven effective in increasing the hygiene bundle compliance for our patients and could mitigate the incidence of hospital acquired conditions and increase both patient and staff satisfaction, and positive outcomes. This work has global implications due to the high nature and use of central lines and can be implemented in any organization where central lines are placed.
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