CenCal Health launched a pilot project to reduce infection-related hospital transfers in Skilled Nursing Facilities (SNFs) based on best practices developed during Project SHIELD, a study conducted by a UC Irvine Epidemiology team from April 2017 through July 2019. The project engaged three high-priority SNFs to implement a new bathing protocol using Chlorhexidine(CHG) soap. The goal was to achieve a 10% reduction in nosocomial infections resulting in acute hospital transfers by the end of 2024. Below are important takeaways from the pilot, as well as best practices that can be applied to SNF settings.
Results
- Year-over-year analysis indicated a 10-27% decrease in infection rates for 2023, preceding full implementation at our participating sites in 2024.
- Compared to 2022, infection rates dropped by 25-33%.
- Compared to 2021, there was a 31-73% decrease.
- Educating both residents and staff was crucial for program adherence.
- Staff observed significant improvements in odor control at the SNFs.
- Notable reduction in upper respiratory infections and COVID-19 cases among staff and SNF residents.
Best Practices
Multidrug-resistant organisms (MDROs) pose a serious risk in nursing homes. The SHIELD program has been shown to reduce MDRO infections and hospitalizations. Below are a few key practices SNFs can implement:
Start Early & Consistently
- Begin decolonization (CHG baths + nasal iodophor) at admission for all residents.
- Continue throughout the resident’s entire stay.
Chlorhexidine Bathing
- Use 2% no-rinse CHG cloths for bed baths OR 4% CHG liquid for showers.
- Massage CHG onto the skin for the best effect.
- Clean 6 inches of any line, tube, or drain closest to the body and over non-gauze dressings.
- Use CHG on superficial wounds, stage 1 and 2 ulcers, rashes, and closed surgical sites.
- Let CHG air-dry fully before applying dressings (about 5 minutes).
- Do NOT mix with soap/shampoo/lotions (this inactivates CHG).
Nasal Iodophor
- Apply twice daily for 5 days starting at admission, then Monday-Friday every other week.
- Encourage residents to blow their noses before application, not after.
- Re-administer iodophor every time a resident is re-admitted.
Resident Engagement
- Explain the infection-prevention benefit to encourage participation.
- Offer baths later if a resident refuses due to pain or timing.
- Provide handouts for residents who self-bathe to ensure proper technique.
Staff Reminders
- Wear gloves and change them if soiled during bathing.
- Do not flush CHG cloths; dispose in the trash.
- Apply CHG with firm massage, especially in skin folds.
- Use the buddy system to train staff on proper CHG use for wounds.
Safety
- Monitor for skin reactions before starting CHG.
- Discontinue and seek medical attention if severe allergic reaction occurs.
- Do not use CHG or iodophor on residents with known allergies.
Resources
The UCI SHEILD toolkit provides SNFs with the tools to systemically adopt a CHG-based bathing protocol to standardize infection-prevention practices, improve staff confidence and resident safety, and align with statewide best practices for reducing healthcare-associated infections. Facilities can choose from protocols for CHG cloth bed baths, liquid basin baths, or CHG showers, with companion nasal iodophor protocols. The toolkit includes practical resources, such as Quality Assurance Performance Improvement (QAPI) planning forms, readiness and pre-launch checklists, staff and resident education materials and communication templates, CHG product and protocol guides, skills assessment tools, compliance audit checklists, side effect monitoring forms, among many more in-depth, valuable tools. Access the toolkit here: UCI Health SHIELD Toolkit
References
- UCI Press Release: UCI Health study finds regional infection control collaboration reduced infections and deaths from antibiotic-resistant organisms
- Reducing Hospitalizations and Multidrug-Resistant Organisms via Regional Decolonization in Hospitals and Nursing Homes
- Controlling Multidrug-Resistant Organisms Across Patient-Sharing Networks
- Decolonization in Nursing Homes to Prevent Infection and Hospitalization