Effect Of Bath Wıth Chlorexıdıne On Protectıon Of Skın Integrıty And Preventıon Of Hospıtal Infectıon
Condition: Health Care Associated Infection; Skin
MeSH terms: Infections; Communicable Diseases; Cross Infection
Study type: Interventional

Summary: 
      The study was designed in a randomized controlled experimental design type to determine the
      effect of a 2% chlorhexidine bath applied in the pediatric intensive care unit on protecting
      skin integrity and preventing hospital-acquired infection. Research data were collected from
      pediatric patients aged 2 months to 18 years old, who were treated in the Pediatric Intensive
      Care Unit of a tertiary education and research hospital between September 2022 and September
      2023. In data collection; "Child Follow-up Form", "Skin Integrity and Nosocomial Infection
      Follow-up Form", and "Northampton Pediatric Skin Evaluation Scale (CCRS)" were used. The data
      were evaluated with appropriate statistical methods in SPSS (Statistical Package for Social
      Sciences) for Windows 24.0 package program.
    

Detailed description: 
      The study is planned to be carried out between September 2022 and September 2023 in the
      15-bed pediatric intensive care unit of Sarıyer Hamidiye Etfal Hospital. Sample size was
      determined by power analysis. Based on the percentage measurement values of the methods to be
      studied in the literature review, the total sample size was found to be n=68, with an effect
      size of 0.8 (cohen), a power of 90%, and a margin of error of 0.05, using the G-POWER
      program. The sample of the study was determined as 68 children, 34 of whom were bathed with
      2% Chlorhexidine soap and 34 children who were bathed with water and soap. The randomization
      of the groups will be determined by drawing lots.

      The pediatric intensive care unit works in two shifts, 08-17 and 16-08. During the research,
      the researcher will be in the clinic during the procedure, bathroom applications will be made
      by the research nurse in the 08-17 shift and recorded in the data collection form. A blood
      culture will be taken at the first hospitalization for each child who meets the acceptance
      and exclusion criteria of the study hospitalized in the pediatric intensive care unit, and
      their names will be written on closed papers by randomization drawing method and randomly
      thrown into the lanterns representing the control and intervention groups prepared
      beforehand. process will be started. Those with negative culture results at their first
      admission to the clinic will be included in the study.

      It is known that healthcare-associated infections occur within 48 to 72 hours of
      hospitalization. For this reason, for both groups included in the study, necessary blood
      tests and cultures will be taken at their first admission to the clinic in order to evaluate
      the effects of the products to be used in the care process on health care-associated
      infections. During the application, children will be monitored daily by suspecting any
      systemic inflammatory response syndrome (such as fever, vomiting, diarrhea) in terms of
      healthcare-associated infections, and in case of any symptoms, their examinations will be
      repeated and recorded in the data collection form.

      For the control and intervention groups, daily bathing will be done during the patient's stay
      in the clinic, skin evaluation will be made with the Northempton Pediatric Skin Evaluation
      Scale before the application, and the application process will begin for the pediatric
      patients whose scale score is between low and medium level and will be evaluated daily after
      the application. If a change is noted in the Northempton Pediatric Skin Rating Scale skin
      score during daily evaluations, the evaluations will continue within the intervals specified
      in the form of the scale, and the study will be terminated for children whose scale score is
      evaluated in the high-risk group. In addition, the evaluation of skin integrity will be
      recorded daily on the data collection form immediately after each application (dryness,
      redness, deterioration of skin integrity/peeling). Immediately after each application and 6
      hours after the FCM-2 Skin Oil and Moisture Meter (With this device, the fat and moisture
      ratios of any part of the body can be determined and the measurements are concluded with high
      precision. Measuring range; 0%…99.9% RH) device. skin moisture values will be measured from
      three different regions, namely forearm, lateral upper leg and abdomen (2 cm above the
      umbilicus) and recorded daily in the data collection form.

      Reproductive findings of healthcare-associated infections will be determined by evaluating
      the results of the samples sent to Sarıyer Hamidiye Etfal Training and Research Hospital
      laboratory.

      In the study, "Northempton Pediatric Skin Evaluation Scale Turkish Version" will be used for
      risk assessment of skin integrity. The validity and reliability of the Turkish version of the
      scale was determined by Uysal et al. (2017) made by The scale is used to evaluate the skin of
      inpatients in pediatric clinics. Scale child's skin; weight, nutritional status, activity,
      bladder/bowel control, pain status, and skin condition. Each subscale consists of a total of
      18 items with certain criteria. The lowest score to be obtained from the items in the scale
      was determined as zero and the highest score as 12. In the scale, 2 points will be added to
      the total score for each of the conditions such as radiotherapy, chemotherapy, steroid
      treatment, diabetes mellitus, staying in surgery for more than 2 hours, having a splint/cast
      in the body, anemia (hb: less than 8), sensory loss. A low risk of skin complications between
      0-4 points in the scale and once-daily evaluation is recommended. A score of 5 to 8 is at
      moderate risk for skin complications, and twice-daily evaluation is recommended. It is
      recommended that skin complications may develop at a high risk with a score of 9 and above,
      and it is recommended to be evaluated every 4-6 hours or according to the situation. The
      higher the score on the scale, the higher the risk of skin complications in children who
      underwent the scale application.

      The data obtained in the research is SPSS (Statistical Package for Social Analysis using the
      Sciences) for Windows 24.0 program will be. Number, percentage, mean and standard deviation
      will be used as descriptive statistical methods in the evaluation of the data. Before the
      data analysis, normality test will be done to test the suitability to the parametric test
      methods. In order to test the normal distribution condition, Kolmogorov Smirnov Z test will
      be applied. Chi-square and Fisher's exact tests will be applied to determine the homogeneity
      of the groups. In line with the results, the data will be analyzed with the related tests
      (Independent t-test, ANOVA, Man Whitney U, Kruskal Wallis). The findings will be evaluated at
      the 95% confidence interval and the significance level of p<0.05.
    

Intervention name(s): 2% chlorhexidine digluconate solution; usual baths
Intervention type(s): Other; Other
Intervention description(s): Bathing will be performed at least daily using 2% chlorhexidine digluconate solution with surface-active agents on all applicable bathing surfaces, which consists of the entire body surface of the patient except eyes, inner ear, oral mucosa, and areas of loss of skin continuity (such as burnt areas, pressure injuries, etc.); Bathing will be performed at least daily using shampoo and water (performed according to the current practice in each center) on all applicable bathing surfaces, which consists of the entire body surface of the patient except eyes, inner ear, oral mucosa, and areas of loss of skin continuity (such as burnt areas, pressure injuries, etc.)
Other intervention name(s): chlorhexidine baths; shampoo and water baths
Intervention MeSH terms: Chlorhexidine; Chlorhexidine gluconate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: skin integrity; health care associated infection