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Archive August 2013 XIV, No. 8

A Better Bath: 3 Days of CHG Application

How we prevented SSIs with a pre-op bathing and wipe regimen for our hip and knee patients.

Stephanie Mayoryk, RN, BSN, CIC


bathe with CHG wipes SPLISH, SPLASH Find out how a hospital got its patients to bathe with CHG wipes.

We'd seen the studies showing that patients who bathed with chlorhexidine gluconate (CHG) for 3 days before surgery had fewer surgical site infections than those who followed the traditional night-before-and-morning-of bathing protocol. But we knew it would be a challenge to get patients to embrace the idea. So when we decided to go for it, we set what we thought was a fairly optimistic goal of 90% compliance. Now, more than a year later, I'm proud to say we've exceeded that goal in every month, have had 100% compliance in several of those months, and overall, have had a 98% success rate. Here's how we did it.

We'd been talking to our joint center team for 2 years about how to better prevent SSIs. We knew the organisms causing infections within our hip and knee patients were predominantly related to patient skin flora. Naturally, we already did pre-op bathing on the morning of surgery, but it wasn't enough. When we got word that the Institute for Healthcare Improvement's Project JOINTS (Joining Organizations IN Tackling SSIs) Collaborative was accepting a second cohort of hospitals, it was a no-brainer for us. We joined in the spring of 2012.

The 3 days of CHG application is one of the key components of the Project JOINTS "enhanced surgical bundle" to prevent infections. And joining the initiative gave us access to a wealth of educational tools, compliance tracking method-ologies, and presentations to help ensure success. Our rollout was pretty smooth. Because our joint center team already had pre-op educational classes in place for all hip and knee patients twice a month, there was no need to reinvent the wheel. Our classes had primarily focused on educating patients about the procedure and what to expect post-op. Now we began to really focus on the prevention aspect, too.

The Project JOINTS program is now a national project and anybody can register on the IHI website ( and gain access to helpful educational material. If you're just now thinking about initiating a pre-op bathing or showering protocol, I recommend starting small. Begin providing bathing or showering instruction to a small group of your highest-risk patients. You may want to start with one kind of surgery, like knees or shoulders. Choose a subset of some sort and make sure you have the process down before you spread it to other service lines.

For those just starting, the IHI recommends selecting 2 patients, discussing the value of CHG bathing before surgery and asking if they'll help you with a process improvement. Doing so gives them an opportunity to have input into their care, and you can point out that they may help improve the care of others. Give them a copy of the patient CHG checklist (available on the IHI website) to complete and bring back before surgery. Then, before surgery, follow up with the patient or patent's family to assess compliance and ask for suggestions.

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