Dedoose software was used to facilitate data

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content analysis to code and analyze the data. Dedoose software was used to facilitate data management and coding. Trustworthiness and scientific integrity of the data were ensured by having two authors corroborate the coding process, conducting member checks and keeping an audit trail of all the decisions made. Results: Duration of the interviews was 15 to 39 min (average = 26 min). Five steps of bathing were identified: 1) decision to give a bath; 2) ability to give a bath; 3) decision about which soap to use; 4) delegation of a bath; and 5) getting assistance to do a bath. The bathing process resulted in one of the following three outcomes: 1) complete bath; 2) interrupted bath; and 3) bath not done. The outcome was influenced by a combination of barriers and facilitators at each step. Most barriers were related to perceived workload, patient factors, and scheduling. Facilitators were mainly organizational factors such asthe policy of daily CHG bathing, the consistent supply of CHG soap, and support such as reminders to conduct CHG baths by nurse managers. Conclusions: Patient bathing in ICUs is a complex process that can be hindered and interrupted by numerous factors. The decision to use CHG soap for bathing was only one of 5 steps of bathing and was largely influenced by scheduling/workload and patient factors such as clinical stability, hypersensitivity to CHG, 4
PICOT STATEMENT AND LITERATURE SEARCHpatient refusal, presence of IV lines and general hygiene. Interventions that address the organizational, provider, and patient barriers to bathing could improve adherence to a daily CHG bathing protocol.Petlin, A., Schallom, M., Prentice, D., Sona, C., Mantia, P., McMullen, K. & Landholt, C. (2014). Chlorhexidine bathing to reduce methicillin-resistant staphylococcus aureus acquisition. Critical Care Nurse 34(5), 17-26. Retrieved from ?direct=true&db=ccm&AN=103899471&site=ehost-live&scope=siteAbstractBACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism causing substantial morbidity and mortality in intensive care units. Chlorhexidine gluconate, a topical antiseptic solution, is effective against a wide spectrum of gram-positive and gram-negative bacteria, including MRSA. OBJECTIVES: To examine the impact of a bathing protocolusing chlorhexidine gluconate and bath basin management on MRSA acquisition in 5 adult intensive care units and to examine the cost differences between chlorhexidine bathing by using the bath-basin method versus using prepackaged chlorhexidine-impregnated washcloths. METHODS: The protocol used a 4-oz bottle of 4% chlorhexidine gluconate soap in a bath basin of warm water. Patients in 3 intensive care units underwent active surveillance for MRSA acquisition; patients in 2 other units were monitored for a new positive culture for MRSA at any site 48 hours after admission. RESULTS: Before the protocol, 132 patients acquired MRSA in 34,333 patient days (rate ratio, 3.84). Afterwards, 109 patients acquired MRSA in 41,376 patient days (rate ratio, 2.63). The rate ratio difference is 1.46 (95% Cl, 1.12-1.90; P=0.003). The chlorhexidine soap and bath basi method cost $3.18 as compared with #5.52 for chlorhexidine-5
PICOT STATEMENT AND LITERATURE SEARCHimpregnated wipes (74% higher). CONCLUSIONS: The chlorhexidine bathing protocol is easy

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