Abstract:
Background: Paediatric oncology patients are highly susceptible to healthcare-associated infections (HAIs), particularly central line-associated bloodstream infections (CLABSIs), due to immunosuppression and frequent central venous catheter (CVC) use. Daily bathing with chlorhexidine gluconate (CHG) has demonstrated efficacy in reducing skin colonization by multidrug-resistant organisms (MDROs), yet compliance remains suboptimal in many settings.
Local problem: At our tertiary cancer centre in Northeast India, baseline compliance with daily CHG bathing among paediatric oncology inpatients was 27%, despite institutional guidelines recommending routine use.
Methods: A multidisciplinary quality improvement project (QIP) was implemented using A3 methodology. Root cause analysis identified key barriers to compliance. Targeted interventions were deployed over a six-month period from October 2024 to February 2025, supported by EQUIP India under the National Cancer Grid. Compliance was tracked using daily audits and run charts.
Results: Interventions included developing a standard operating procedure (SOP), structured training for staff and caregivers, infrastructure improvements, and enhanced logistical support. Following implementation, mean weekly chlorhexidine gluconate (CHG) bathing compliance improved from a baseline of 27% to 64% by February 2025, exceeding the project target of 60%.
Conclusions: A structured, multi-faceted QIP can significantly improve and sustain adherence to CHG bathing protocols in a resource-constrained pediatric oncology setting. Daily chlorhexidine gluconate (CHG) bathing is a low-cost, scalable intervention that enhances infection control. Stakeholder engagement and addressing systemic barriers are critical for success.
Reference:Barman R, Talukdar A, Shangnung L, Hazarika M, Borthakur BB, Laskar SG. Shielding little warriors: enhancing hygiene with chlorhexidine bathing in paediatric oncology – a quality improvement initiative. BMC Health Serv Res. 2026 May 20. doi: 10.1186/s12913-026-14610-2. Epub ahead of print. PMID: 42163245.