HCT Patients Back CHG Bathing at Home But Need Reminders and Caregiver Help

Hematopoietic cell transplantation (HCT) carries serious infection risk, with 13–55% of recipients experiencing bloodstream infections (BSIs). Chlorhexidine gluconate (CHG) bathing has proven effective at reducing BSI rates, and prior research from the same team showed that patients with high daily CHG adherence (>75%) had only 8% BSI incidence versus 30% in non-users. As HCT care increasingly shifts to outpatient settings — yielding quality-of-life benefits and cost savings of up to 33% — understanding how patients manage CHG bathing at home becomes critical.

This qualitative descriptive study recruited 14 HCT recipients (mean age 51±16 years; 64% female) from Duke University's inpatient transplant unit between April 2022 and April 2023. Semi-structured interviews were conducted within three months post-discharge via phone, video, or in person. A rapid qualitative analysis method was used — coding directly from recordings into a structured Excel template — rather than full transcription. Sample size was determined by the principle of information power, with saturation assessed iteratively after the first 10 and then 14 interviews.

Three primary themes emerged: feasibility, challenges to sustained adherence, and support needs. On feasibility, most participants viewed outpatient CHG bathing positively, noting that CHG wipes were a practical alternative to showering when physically weak and that home infection risk arguably made CHG even more important than in the hospital. On challenges, participants anticipated declining motivation once removed from hospital oversight, with fatigue and competing household responsibilities cited as common barriers. Cold wipe temperature was a recurring deterrent, and physical difficulty reaching the back and other areas — compounded by age or fatigue — posed self-administration hurdles. On support needs, participants prioritized structured reminders (alarms, checklists), integration of CHG into fixed daily routines, caregiver involvement for physical assistance and accountability, and regular clinical check-ins. Education emerged as a cross-cutting theme: patients who understood the infection-prevention rationale for CHG felt more motivated to comply.

The study's implications are directly actionable. Transplant programs expanding outpatient HCT pathways should build CHG adherence support into discharge planning, including caregiver training, written or app-based reminder systems, and routine outpatient follow-up questions about bathing compliance. Warming wipes before use — a simple practical tip — was spontaneously suggested by multiple patients and could meaningfully lower the cold-temperature barrier. Patient education materials should clearly link CHG use to measurable infection-risk reduction to reinforce motivation.

Caveats include the small, relatively homogeneous single-center sample (predominantly middle-aged women at one academic transplant center), reliance on anticipated rather than observed home behavior, and the rapid analysis method which, while rigorous, foregoes full transcription. Findings should be validated in larger, more diverse populations before broad implementation.