Date of Graduation

Fall 12-16-2016

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


The organization-wide implementation of Chlorhexidine Gluconate (CHG) bathing protocol is one of many measures used to help reduce hospital-acquired infections (HAI) at the 30-bed, Medical-Surgical Specialties and Palliative Care Unit. CHG bathing compliance rate for the unit for the week of August 14-20 was 82.9%, with a 40.4% refusal rate. This is below the 90% desired performance rate. The purpose of this project is to identify the barriers to CHG compliance and to implement interventions that will aid in reducing these barriers and increase CHG compliance rate. Patient declining was identified as one of the main barriers to CHG bathing. The specific aim of the project is to reduce the number of patients who decline CHG bathing in the unit by 30% by the end of November 2016. A cause and effect analysis was done to explore the reasons for noncompliance to CHG bathing. Direct observations, nurse surveys, and EMR documentation reviews were performed to gather data. Results revealed the need to provide teaching and visual reminders to staff nurses and provide education to patients in the efficacy of CHG bathing in infection prevention. Staff nurses received education on CHG bathing protocol. Visual reminders were placed in common areas. Informational handouts were placed in each admission folder to help patients understand the benefits of CHG bathing as well as the potential risk of their refusal. CHG bathing compliance rate for the week of November 6-12 was 90.9%, with a refusal rate of 31.5%. This showed an 8% increase in compliance and a 22% reduction in the number of patients refusing CHG bathing.

Included in

Nursing Commons