Exploring Perspectives on Feasibility, Challenges, and Support Needs for Chlorhexidine Gluconate (CHG) Bathing in the Outpatient Setting for Hematopoietic Cell Transplant Recipients: A Qualitative Study

Marie-Michèle Sainvil, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.. Electronic address: michele.sainvil@duke.edu.
Ashley L. Artese, Department of Exercise Science and Health Promotion, Florida Atlantic University, Boca Raton, FL, USA.; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC, USA.
Laura J. Fish, Department of Family Medicine and Community Health, Duke University School of Medicine, and Duke Cancer Institute Behavioral Health and Survey Research core, Durham, North Carolina, USA.
Chukwuamaka M. Onyewadume, Department of Epidemiology, George Washington University, Milken Institute School of Public Health, Washington, DC, USA.
Joane Titus, Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, Florida, USA.
Safia Gecaj, Department of Exercise Science and Health Promotion, Florida Atlantic University, Boca Raton, FL, USA.
Lauren Hill, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.
Tamara Somers, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
Anita Matthews, Duke University Health System Nursing, Durham, NC, USA.
Deborah H. Allen, Duke University Health System Nursing, Durham, NC, USA.
Elizabeth Sito, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.
Tessa M. Andermann, Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Andrew R. Rezvani, Division of Blood & Marrow Transplantation and Cellular Therapy, Stanford University, Stanford, CA, USA.
Taewoong Choi, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.
Mitchell E. Horwitz, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.
Richard D. Lopez, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.
David A. Rizzieri, Novant Health, Winston Salem, NC, USA.
Stefanie Sarantopoulos, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.
Nelson J. Chao, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.
Sanghee Hong, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.; Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.
Anthony D. Sung, Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA.; Department of Exercise Science and Health Promotion, Florida Atlantic University, Boca Raton, FL, USA.; Division of Hematologic Malignancies and Cellular Therapy, Kansas University, Kansas City, KS, US.

Document Type

Journal Article

Publication Date

9-19-2025

Journal

Transplantation and cellular therapy

DOI

10.1016/j.jtct.2025.09.021

Keywords

Chlorhexidine gluconate; hematopoietic cell transplantation; infection risk; qualitative research

Abstract

BACKGROUND: Chlorhexidine gluconate (CHG) bathing is recommended for infection prevention in hematopoietic cell transplantation (HCT) patients. As more centers transition HCT care to outpatient settings, understanding patients' perceptions of CHG bathing feasibility, support needs, and home-based barriers in the home environment is critical to promoting adherence. OBJECTIVE: This study explores HCT patient perceptions regarding feasibility of CHG bathing in the outpatient setting to identify barriers and support needs. STUDY DESIGN: We conducted a qualitative descriptive study with 14 HCT (mean 51±16 years) recipients recruited from an inpatient transplant unit. Semi-structured interviews were conducted via phone, video, or in person within three months post-discharge. A rapid qualitative analysis approach was used to identify key sub-themes related to feasibility, challenges, and needed support. RESULTS: Participants supported the feasibility of CHG bathing in the outpatient setting and were supportive of its continued use post-discharge. Participants sited potential challenges including lack of motivation, home management difficulties, and administration concerns. Participants identified the need for structured reminders and accountability, caregiver support, and clinical follow-up. The importance of education emerged as a salient theme. Suggestions for improving adherence included integrating CHG bathing into daily routines and enhancing patient education. CONCLUSION: While CHG bathing in the outpatient setting is feasible, targeted interventions, such as education, reminders, and caregiver involvement may improve adherence and optimize infection prevention. Findings from this study can inform the application of CHG in the outpatient setting and development of innovative, patient-driven strategies to improve CHG adherence. Future efforts should focus on addressing identified barriers to support successful outpatient implementation.

Department

Epidemiology

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