Delivering a safe recovery: The importance of patient hygiene in improving infection prevention outcomes
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The COVID-19 pandemic has made us all more aware of the risks of developing an infection. Yet, as with so many other areas of patient care, the challenge of COVID-19 has lessened our collective focus on other types of infection, such as healthcare-associated infections (HCAIs).
If left unchecked, the long-term implications of HCAIs could be significant, placing even greater demands on overstretched nursing and infection prevention teams and the NHS as a whole.
The work of nurses in mitigating HCAIs is significant. In reflecting on their importance, it is crucial to ensure that they, and wider infection prevention teams, have the most effective tools available to ensure that patients have the best quality of care. Daily whole body washing with a chlorhexidine gluconate (CHG) based solution, is one such measure that can make a significant difference to patient outcomes.1
Risk of HCAIs for the NHS
Since the pandemic, HCAI cases have increased significantly.2 Their scale and impact are considerable. They constitute a significant financial burden on the NHS, costing an estimated £1 billion per year, with £56 million of this incurred after patients are discharged from hospital.3,4 Mitigation strategies reliant on soap and water bathing techniques do not adequately address the challenge of HCAIs in at-risk patient demographics.5 Improving infection prevention control measures is therefore an effective means of reducing preventable illnesses, bringing down costs and, most importantly, protecting patients across the clinical pathway.
Whole body washing in promoting patient health
Whole body washing helps lower the risk of HCAIs by cleaning patients through skin antisepsis.6 In particular, treatments that use a 4 per cent CHG solution have been proven to kill pathogens on contact.7 Unlike soap and water preoperative washes, patients offered whole body washes are reported to have less adverse skin conditions, fewer complications and are less likely to be readmitted to hospital.8,9 This offers nurses a highly effective means to ensure that patients can recover from their surgeries in a safe and healthy manner.
Prevention as the best cure: whole body washing promotes readmissions and promotes a healthy recovery
Whole body washing acts as a preventative tool, which unlike soap and water techniques, can reduce readmission rates and rates of infection.10 When whole body washes were utilised by Guys and St Thomas’ NHS Foundation Trust, nurses and clinicians found that it led to a sustained reduction and almost total elimination of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia from the ICU units.11 A joint study conducted across eight Trusts found that implementing whole body washing in the hospital environment resulted in a 39 per cent drop in patients developing an infection in hospital. Whole body washing was also found to help mitigate the risks posed by dangerous HCAIs such as Vancomycin-resistant Enterococcus (VRE), MRSA, and Infections from central venous catheters, at surgical sites or from ventilator use.12
Whole body washing also serves as a holistic process to promote high quality hospital hygiene, that not only mitigates the risks of HCAIs but also acts as a preventative tool. At a time when NHS resources are spread thin, the initial investment in whole body washes can pay dividends through reduced equipment usage and reduced patient bed days. The Royal Brompton NHS Trust has found that using 4 per cent CHG whole body washes helped patients recover with reduced risks from becoming reinfected.13
Conclusion
It is now more important than ever for trusts to reflect on the numerous benefits that daily whole body washing offers for patients. With the heightened risk of HCAIs, we owe it to our patients and nurses to drive a change in hygiene practices that can protect them from illnesses and help to deliver a safe recovery for all.
1 Lewis, S., Schofield-Robinson, O., Rhodes, S. and Smith, A., 2019. Chlorhexidine bathing of the critically ill for the prevention of hospital-acquired infection. Cochrane Database of Systematic Reviews
2 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/961210/S1056_Contribution_of_nosocomial_infections_to_the_first_wave.pdf
3 Assets.publishing.service.gov.uk. 2022. [online] Available at: <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/212798/Sage-2-percent-Chlorhexidine-Gluconate-Cloth.pdf> [Accessed 5 April 2022].
4 Nice.org.uk. 2022. Introduction | Healthcare-associated infections: prevention and control in primary and community care | Guidance | NICE. [online] Available at: <https://www.nice.org.uk/guidance/cg139/chapter/introduction#:~:text=Healthcare%2Dassociated%20infections%20are%20estimated,patients%20are%20discharged%20from%20hospital.> [Accessed 4 May 2022].
5 Nice.org.uk. 2022. Overview | Surgical site infections: prevention and treatment | Guidance | NICE. [online] Available at: <https://www.nice.org.uk/guidance/NG125> [Accessed 7 April 2022].
6 https://www.who.int/infection-prevention/tools/surgical/appendix2.pdf
7 Denton GW; 2001. Chlorhexidine. Chapter 15 in Disinfection, Sterilization and Preservation. Ed. Block SS. Fifth Ed. Lippincott Williams and Wilkins
8 Swan, J., Ashton, C., Bui, L., Pham, V., Shirkey, B., Blackshear, J., Bersamin, J., Pomer, R., Johnson, M., Magtoto, A., Butler, M., Tran, S., Sanchez, L., Patel, J., Ochoa, R., Hai, S., Denison, K., Graviss, E. and Wray, N., 2016. Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU. Critical Care Medicine, 44(10), pp.1822-1832.
9 Tanner J et al. A fresh look at perioperative body washing. Journal of Infection Prevention. 2012; (13) 11 – 15.
10 Swan, J., Ashton, C., Bui, L., Pham, V., Shirkey, B., Blackshear, J., Bersamin, J., Pomer, R., Johnson, M., Magtoto, A., Butler, M., Tran, S., Sanchez, L., Patel, J., Ochoa, R., Hai, S., Denison, K., Graviss, E. and Wray, N., 2016. Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU. Critical Care Medicine, 44(10), pp.1822-1832.
11 Wyncoll D, Shankar-Hari M, Beale R; 2015. Daily Bathing with 2% CHG Washcloths Leads to Almost Total Elimination of MRSA Bacteraemia. King’s Health Partners
12 Assets.publishing.service.gov.uk. 2022. [online] Available at: <https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/212798/Sage-2-percent-Chlorhexidine-Gluconate-Cloth.pdf> [Accessed 5 April 2022].
13 Rbht.nhs.uk. 2022. [online] Available at: <https://www.rbht.nhs.uk/sites/nhs/files/PILs/Your%20pre-operative%20skin%20wash%20-%20June%202014.pdf> [Accessed 7 April 2022].
