The utility of electronic health record-based hygiene notes for chlorhexidine bathing practice evaluation

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2 Scopus citations


Background: Unreliable compliance with infection prevention procedures necessitates an analysis of contributing factors. Methods: A retrospective study explored utility of 3236 nursing hygiene notes in the electronic healthcare record system (EHR). This 2012–2013 study identified defects in the chlorhexidine (CHG) bathing practice for a hospital unit. Results: The overall compliance with CHG bathing was 22.99%. Patients with length of stay less than 3 days, in most cases, did not have documentation for CHG bathing. Patient refusal to bathe was the most prevalent documented reason (66%) of the unsuccessful initial and repeated offers to bathe. The regular staff were statistically less successful in convincing patients to bathe. The 1455 notes produced by the regular staff (n = 10) demonstrated a significantly higher failure rate (56.08%) to execute this procedure in comparison with 1770 notes documented by the 246 temporary staff (31.19% failure rate) (P value <0.001). Discussion: This analysis yielded three main insights: lack of the CHG documentation in a large number of short admissions; inconsistent use of CHG baths; and presence of workarounds due to patient refusals to bathe. The study concluded that EHR structured and unstructured data can unlock the opportunity for identifying hidden defects and inform decision-makers about the need for change.

Original languageEnglish (US)
Pages (from-to)72-77
Number of pages6
JournalJournal of Infection Prevention
Issue number2
StatePublished - Mar 1 2017


  • Healthcare-associated infections
  • compliance
  • qualitative research

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Advanced and Specialized Nursing
  • Infectious Diseases


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