# 312. Chlorhexidine Gluconate (CHG) Skin Concentration Measurement and Feedback in Hematology-Oncology and Hematopoietic Stem Cell Transplant (HO/HSCT) Units: A Multicenter Study

## TL;DR

This study measured how well chlorhexidine gluconate (CHG) is applied on patients' skin in hospital units and found that providing feedback to staff did not improve CHG application quality.

## Contribution

The study introduces a method to assess CHG bathing quality through skin concentration measurements and evaluates the impact of feedback on improvement efforts.

## Key findings

- CHG skin concentrations varied significantly between hospital units.
- Providing feedback to unit staff did not lead to improved CHG skin concentrations.
- CHG-impregnated cloth and staff assistance were linked to higher CHG concentrations.

## Abstract

The quality of CHG bathing for infection prevention in HO/HSCT units is uncertain, as patients are often self-bathing. We assessed CHG bathing quality by measuring patients’ CHG skin concentrations at baseline and then evaluated whether feedback of results to unit leadership/staff could guide improvement.Table.Demographics and Clinical Factors for Patients in Hematology-Oncology/Hematopoietic Stem Cell Transplant Units from Six Hospitals (N=736)Figure 1.Baseline Chlorhexidine Gluconate Skin Concentrations in Six Hematology-Oncology/Hematopoietic Stem Cell Transplant Units (N=379)

Demographics and Clinical Factors for Patients in Hematology-Oncology/Hematopoietic Stem Cell Transplant Units from Six Hospitals (N=736)

Baseline Chlorhexidine Gluconate Skin Concentrations in Six Hematology-Oncology/Hematopoietic Stem Cell Transplant Units (N=379)

We conducted 6 point prevalence surveys from 9/2023 – 10/2024 in HO/HSCT units that performed routine CHG bathing at 6 hospitals. During each survey, we collected swab samples of patients’ skin (neck, axilla, inguinal region) and clinical data. We used a colorimetric assay to measure CHG skin concentrations (detection range ≥4.9 to 20,000 µg/ml). During surveys 1-3 (baseline period), CHG concentrations were measured but not shared. During surveys 4-6 (intervention period), summary CHG concentrations from baseline and after each intervention period survey were shared with unit leadership/staff, who led local quality improvement initiatives. We used linear and logistic regression to model outcomes, controlling for clustering as appropriate.Figure 2.Modeled Chlorhexidine Gluconate Skin Concentrations between Baseline and Intervention Periods in Hematology-Oncology/Hematopoietic Stem Cell Transplant Units from Six Hospitals (N=736)

Modeled Chlorhexidine Gluconate Skin Concentrations between Baseline and Intervention Periods in Hematology-Oncology/Hematopoietic Stem Cell Transplant Units from Six Hospitals (N=736)

Six units participated (median 34 beds/unit); 3 units only used 2% CHG-impregnated cloth, and 3 units used bathing approaches that included other CHG formulations (4% CHG liquid or foam). Of 949 eligible patients, 83% consented to participate; after deduplication, 736 unique patients were analyzed (Table). 87% of patients reported using CHG. At baseline, 22% of 379 patients had undetectable CHG skin concentrations on all 3 body sites; CHG concentrations varied by unit (P< .001, Figure 1). In adjusted analyses, there was no difference between baseline and intervention periods in CHG skin concentration levels (P=.73; Figure 2) or CHG detection on any body site (P=.40). CHG-impregnated cloth-exclusive units had 4-fold higher CHG skin concentrations than non-cloth exclusive units (P=.005). Patients who had CHG baths performed by staff only or with staff assistance had 31% higher CHG skin concentrations than those without staff involvement (P=.02).

We found significant variation in CHG bathing quality among HO/HSCT patients and between units; unit-level feedback of CHG measurements did not lead to improvement. We identified CHG formulation and staff assistance with CHG bathing as potential modifiable factors.

Erik Dubberke, MD, MSPH, AstraZenca: Advisor/Consultant|AstraZenca: Grant/Research Support|Pfizer, Inc.: Advisor/Consultant|Pfizer, Inc.: Grant/Research Support|Theriva Biologics: Grant/Research Support|Vedanta Biosciences, Inc.: Advisor/Consultant|Vedanta Biosciences, Inc.: Grant/Research Support