Chlorhexidine-Impregnated Dressing for Prevention of Catheter-Related Bloodstream Infection

Abstract

Background Catheter related bloodstream infections (CRBSI) are associated with significant morbidity and mortality and effective methods for their prevention are needed. Objective To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter-related colonization and CRBSI using meta-analysis. Data Sources Multiple computerized database searches supplemented by manual searches including relevant conference proceedings. Study Selection Randomized controlled trials (RCT) evaluating the efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and CRBSI. Data Extraction Data were extracted on patient and catheter characteristics and outcomes. Data Synthesis Pooled estimates of the relative risk (RR) and 95% confidence intervals (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenszel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I2. Subgroup analyses were used to explore heterogeneity. Results Nine RCTs met the inclusion criteria. Use of a chlorhexidine-impregnated dressing resulted in a reduced incidence of CRBSI (random effects RR 0.57, 95% CI 0.42–0.79, P=0.002). The incidence of catheter colonization was also markedly reduced in the chlorhexidine-impregnated dressing group (random effects RR 0.51, 95% CI 0.39–0.67, P< 0.001). There was significant benefit for prevention of catheter colonization and CRBSI, including arterial catheters used for hemodynamic monitoring. Other than in low birth weight infants, adverse effects were rare and minor. Conclusions Our analysis shows that a chlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and, more importantly, CRBSI and warrants routine use in patients at high risk of CRBSI and CVC or arterial catheter colonization in ICUs.

What is new for the prevention of catheter-related bloodstream infections?

“…In the RCT published in 2012 by Timsit et al, which included 4,163 CVC and arterial catheters from critically ill patients, was reported a significant lower incidence of CRBSI with the use of chlorhexidine impregnated dressing compared to standard dressings (15). In a meta-analysis published by Safdar et al in 2014, including 9 RCTs and 11,247 catheters, was found that the use of impregnated dressing reduced the risk of CRBSI (16). In addition, a cost-effectiveness analysis recently published in June of 2015 by Maunoury et al found that antimicrobial chlorhexidine gluconate dressing is more cost-effective that non-antimicrobial transparent dressings using a health economic model (17).…”

Infection Control Bundles for the Prevention of Hospital Infections

“…Standart kateter örtüleri ve antiseptikli yarı geçirgen şeffaf örtülerin karşılaştırıldığı bir çalışmada SKİ-KDE hızları sırası ile 1000 kateter gününde 6,50 ile 1,50 olarak hesaplanmıştır [37] . Özellikle klorheksidinli kateter örtülerinin bakteri kolonizasyonunu ve enfeksiyon riskini azaltması ve maliyet etkin olduklarının bildirilmesi, kullanım önerilerini arttırmıştır [38,39] . Klorheksidinli antiseptik solüsyonlarının sadece kateter örtülerinin yanısıra kateter uygulaması ve bakımında da kullanılması ile kateter çevresinde ve kendisinde mikroorganizma kolonizasyonunu azaltarak SKİ-KDE hızını azalttığı bildirilmektedir [40] .…”

Frequency of change of chlorhexidine-impregnated gel dressings for central venous catheters in critically ill patients

“…An ideal dressing must be able to prevent infections, properly fix the catheter, provide comfort, avoid skin irritations, and be easily applied and cost effective. 3,[9][10][11][12] There have been discussions on whether skin antisepsis with chlorhexidine-alcohol alone performed during the insertion of intravascular devices and in CVC dressings is sufficient to prevent and control skin colonization around the insertion site and, consequently, intravascular catheter-related infections. 9,11 The literature evidenced the presence of remaining bacteria that may colonize the CVC even after this antisepsis process.…”

“…3,[9][10][11][12] There have been discussions on whether skin antisepsis with chlorhexidine-alcohol alone performed during the insertion of intravascular devices and in CVC dressings is sufficient to prevent and control skin colonization around the insertion site and, consequently, intravascular catheter-related infections. 9,11 The literature evidenced the presence of remaining bacteria that may colonize the CVC even after this antisepsis process. 5,9,11 Therefore the importance of the use of chlorhexidine-impregnated dressings is emphasized.…”

“…3,5,7 Considering that catheter-related infections are associated with increased morbidity and mortality of patients using intravascular devices and hospital-related costs, prevention and control measures are recommended and adopted aiming at mitigating these issues. 5,8,9 One of these measures is the use of occlusive dressings at the CVC insertion site. An ideal dressing must be able to prevent infections, properly fix the catheter, provide comfort, avoid skin irritations, and be easily applied and cost effective.…”