CHG allergy impact on CLABSI rates
Abstract:
Background: Patients with central venous catheters (CVC) are at increased risk of having a Central Line-associated Bloodstream Infection (CLABSI). CLABSI increase hospital length of stay, costs, and patient morbidity. Through the use of nationally accepted cares, the CLABSI prevention bundle, we strive for zero CLABSI. Part of the bundle is that patients with a CVC receive a chlorhexidine gluconate (CHG) treatment daily, have a CHG impregnated disk placed at the insertion site, and receive CHG based skin antisepsis prior to procedures. In the CLABSI root cause analysis for 2018, allergy to CHG was identified as a contributing factor. Often these are potentially contact dermatitis and are parent reported with no standardized method to re-test or consistent guidance on what skin antisepsis to use in place of CHG. How can we reintroduce CHG products and standardize skin antisepsis for CVC care if the patient has a potential CHG allergy?
Methods: For 9/1/2017 through 8/31/2018 patients with a documented CHG allergy were identified. A multidisciplinary workgroup was assembled. A literature review, chart reviews, and knowledge sharing with similar institutions were completed. Literature was limited with the majority of reports on anaphylaxis reaction (vs dermatitis) and provided no evidence-based standard. In a review of ∼100 patients, only 20 had a documented allergy.
Results: Based upon the findings an algorithm for CVC contact dermatitis was created and implemented. We attempted to standardize skin patch testing with various CVC products, published an algorithm of alternative CVC care for patients with a potential CHG allergy, and created a family education sheet on the highest used alternative, betadine.
Conclusions: A limited pilot of the algorithm showed 67% of the patients included had skin improvement when using the algorithm. A bloodstream infection while having dermatitis was identified in 78% of patients. In 2020 the number of CHG allergy patients decreased by 26%.
Reference:
Renee C. Lehane, Jennifer Ormsby, Can We Improve Central Line Care Compliance by Standardizing How We Identify Chlorhexadine Gluconate Allergies? American Journal of Infection Control. ISR 15| VOLUME 49, ISSUE 6, SUPPLEMENT , S7, JUNE 01, 2021. DOI:https://doi.org/10.1016/j.ajic.2021.04.027.