Implementing Chlorhexidine Skin Preparation to Improve Antimicrobial Skin Preparation for Neuraxial Anesthetics

Abstract

Problem: In a small community hospital, Povidone-Iodine (PVP-I) is the primary skin preparation for regional anesthetics despite evidence that chlorhexidine gluconate in alcohol (CHG-alcohol) is more effective at decreasing bacterial colonization on the skin and catheter tips. 35 knee and hip arthroplasty procedures with neuraxial anesthesia occur weekly. with 89% receiving PVP-I skin preparation due to CHG-alcohol unavailability. Purpose: This quality improvement initiative aimed to improve antimicrobial skin preparation by increasing the availability of CHG-alcohol for skin preparation in adults receiving neuraxial anesthesia for hip or knee surgeries. Methods: The project lead worked with site leaders to ensure adequate supply of CHG-alcohol for the anesthesia department and in the operating rooms. Staff were educated, and attendance and stocking data were collected via direct observation on week one. CHGalcohol use compliance was monitored weekly via chart review and EPIC-generated reports— staff received weekly updates. Adults receiving neuraxial anesthesia for total knee or total hip arthroplasty procedures were included; exclusions were a chlorhexidine allergy. Strategies included early adopters, change champions, collaboration, communication, and increased accountability and buy-in. Team members included the project lead, site sponsor, clinical site representative, anesthesia technicians, and anesthesia providers. Results: All 41 anesthesia providers received written education, and 38 attendees attended the in-person education sessions. CHG-alcohol supply was 100% available. 545 patients were included and three were excluded. After improving availability, CHG-alcohol use increased to a median compliance of 77% and averaged 77% compared to 11% pre-implementation. Conclusions: Findings suggest increased availability of CHG-alcohol improved compliance with CHG-alcohol skin preparation.