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Implementation Strategies to Improve Evidence-Based Bathing Practices in a Neuro ICU

Reynolds, Staci Sue, PhD, RN, ACNS-BC, CCRN, CNRN, SCRN; Sova, Chris, BSN, RN; McNalty, Bridget, RN; Lambert, Suzanne, BSN, RN, SCRN; Granger, Bradi, PhD, RN, FAAN

doi: 10.1097/NCQ.0000000000000347

Background: Evidence supports daily bathing using chlorhexidine gluconate (CHG) cloths to decrease preventable hospital-acquired central line–associated bloodstream infections (CLABSIs). However, implementation of this practice is inconsistent. Using multifaceted strategies to promote implementation is supported in the literature, yet there is a gap in knowing which strategies are most successful.

Purpose: Using the Grol and Wensing Model of Implementation as a guide, the purpose of this study was to determine whether using tailored, multifaceted strategies would improve implementation of daily CHG bathing and decrease CLABSIs in a large neuro ICU.

Methods: An observational pre-/postdesign was used.

Results: Following implementation, infection rates decreased (P = .031). Statistically significant improvements were also seen across all process measures: bathing documentation, nursing knowledge, and perceived importance of CHG bathing.

Conclusions: This study assists in closing the research-practice gap by using tailored, multifaceted implementation strategies to increase use of evidence-based nursing care for infection prevention practices.

Duke University Hospital (Drs Reynolds and Granger, Mr Sova, and Mss McNalty and Lambert) and Duke University School of Nursing (Drs Reynolds and Granger), Durham, North Carolina.

Correspondence: Staci Sue Reynolds, PhD, RN, ACNS-BC, CCRN, CNRN, SCRN, Duke University School of Nursing, 307 Trent Dr, Durham, NC 27710 (

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The authors declare no conflicts of interest.

Accepted for publication: May 23, 2018

Published ahead of print: July 2, 2018

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