Shielding little warriors: enhancing hygiene with chlorhexidine bathing in paediatric oncology - a quality improvement initiative.
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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.