Chlorhexidine Bathing to Prevent Central Line-Associated Bloodstream Infections in Hematology Units: A Prospective, Controlled Cohort Study.

BACKGROUND: Chlorhexidine (CHG) bathing decreases the incidence of bloodstream infections in intensive care units, but its effect has been understudied in patients with hematological malignancies in noncritical care units. METHODS: Adults with hematological malignancies hospitalized for cytotoxic chemotherapy in noncritical care units were offered daily 2% CHG bathing. We compared outcomes of patients who chose CHG bathing (CHG group) with outcomes of those who did not choose CHG bathing (usual-care group). The primary outcome was gram-positive cocci-related, skin flora-related, or central line-associated bloodstream infection. The negative control outcome was gut-origin bacteremia. RESULTS: The CHG group (n = 485) had a crude incidence rate of the primary outcome that was 60% lower than the rate for the usual-care group (n = 408; 3.4 vs 8.4 per 1000 patient-days, P = .02) but had a similar crude incidence rate of the negative control outcome (4.5 vs 3.2 per 1000 patient-days; P = .10). In multivariable analyses, CHG bathing was associated with a 60% decrease in the primary outcome (adjusted hazard ratio [HR], 0.4; P < .001). In contrast, CHG bathing had no effect on the negative control outcome (adjusted HR, 1.1; P = .781). CHG bathing was well tolerated by participants in the CHG group. CONCLUSIONS: CHG bathing could be a highly effective approach for preventing gram-positive cocci-related, skin flora-related, or central line-associated bacteremia in patients with hematological malignancies who are hospitalized for cytotoxic chemotherapy in noncritical care units.

Social support as influencing primary family caregiver burden in Taiwanese patients with colorectal cancer.

PURPOSE: The main purpose of this study was to describe the level of experienced burden among Taiwanese primary family caregivers (PFCs) of patients with colorectal cancer (CRC). Another purpose was to explore the relationship between demographic variables, perceived social support, and caregiver burden. DESIGN: A cross-sectional study. METHODS: This cross-sectional study included 100 PFCs of postsurgery colorectal cancer patients (CCPs) in one teaching hospital in the Taipei area of Taiwan. The research instruments included the Caregiver Reaction Assessment and the Medical Outcome Study-Social Support Survey. FINDINGS: The caregivers' total burden mean was 3.00 (SD= 0.50, range = 2.00-4.19). Social support demonstrated a significant relationship with family caregiver burden (impact on health: r=-0.48, p < .01; impact on schedule: r=-0.58, p < .01; impact on finances: r=-0.44, p < .01; lack of family support: r=-0.54, p < .01; and impact on total scale: r=-0.64, p < .01). Higher perceived social support reported by caregivers predicted lower caregiver burden. Multivariate analysis identified social support as a significant independent influence on caregiver burden after controlling for key demographic variables. Social support accounted for 33% (R(2) increment = 0.33, p < .001) of the variance in caregiver burden. CONCLUSIONS: The study highlights the importance of social support on caregiver burden in this population. Future interventions should include social support to help alleviate caregiver burden in CCPs following surgery. CLINICAL RELEVANCE: Results of this study emphasize the important role of social support to enable healthcare professionals to become more effective while caring for caregivers of the patient with CRC who has undergone surgery. The findings of the present study may facilitate cross-cultural comparison and cultural-oriented management of caregiver burden.