Step wise protocol for body wash in critically ill patients in intensive care units: An area/culture oriented approach

Background: During active surveillance done by Biswal et al. in 2017, to investigate fungal colonisation and infection in the trauma intensive care unit, several flaws were recorded in patient body wash protocol. Candida auris colonisation was rapidly increasing due to improper body washing. Several patients admitted eventually got colonised with C. auris at different body sites, predominantly in axilla and groin. Aims: To devise a novel and simplified chlorhexidine-based body wash protocol to eradicate bacterial and fungal colonisers. Materials and Methods: A detailed, systematic, standard and practical protocol for body wash depending on the specific work culture and resource availability is required to ensure standard nursing care. Therefore, a simplified chlorhexidine based, step wise body wash protocol to eradicate fungal colonisers which can be implemented and followed in every hospital setting was designed. This new protocol was implemented in the trauma intensive care unit (ICU) for 1 month. Successful implementation of the decolonisation procedure was assessed based on the feedback obtained from the nursing staff. Results: The newly devised chlorhexidine based body wash protocol was successfully able to decolonise C. auris from the body sites such as axilla and groin of ICU patients. Easy and simplified protocol could be followed by nursing staff as well as patient attendants. Nursing staff provided positive feedback in implementing and following the new protocol. Conclusion: The protocol can be easily implemented in any hospital settings with minimum resources. This new protocol can significantly reduce fungal and bacterial colonisation and hospital acquired infections.