Efficacy of chlorhexidine patches on central line‐associated bloodstream infections in children

Abstract

Background Central line‐associated bloodstream infections (CLABSIs) are important hospital‐acquired infections. Chlorhexidine‐impregnated dressings (also known as chlorhexidine patches, CHG patches) are reported to decrease CLABSIs in adults. This study aims to determine the efficacy of CHG patches in reducing CLABSIs in children. Methods An open‐label randomized controlled trial was conducted in children aged 2 months to 18 years, requiring a short‐term catheter. Patients were randomized into two groups, allocated to receive CHG patches or standard transparent dressings. Care of the catheter was in accordance with Asia Pacific Society of Infection Control (APSIC) recommendations. Central‐line‐associated bloodstream infections were defined using National Healthcare Safety Network surveillance criteria. Results From April 2017 to April 2018, 192 children were enrolled. There were 108 CHG patch catheters and 101 standard dressing catheters, contributing to 3,113 catheter days. The median duration of catheter dwelling was 13 days, with an interquartile range (IQR) of 8–20 days. Half were placed at the jugular vein and 22% at the femoral vein. There were 23 CLABSI events. Incidence rates for CHG patches and standard dressings were 7.98 (95% confidence interval (CI), 4.25–13.65) and 6.74 (95% CI, 3.23–12.39) per 1,000 catheter days, respectively (incidence rate ratio 1.18; 95% CI, 0.52–2.70). The CLABSI pathogens were 15 Gram‐negative bacteria, six Gram‐positive bacteria, and two Candida organisms. Catheter colonization of CHG patches and standard dressings were 2.02 (95% CI, 0.42–5.91) and 3.07 (95% CI, 1.00–7.16) per 1,000 catheter days, respectively. Only local adverse effects occurred in 6.8% of the participants. Conclusions In our setting, there was no difference in CLABSI rates when the chlorhexidine patch dressings were compared with the standard transparent dressings. Strengthening of CLABSI prevention bundles is mandatory.

Comparison of chlorhexidine impregnated dressing and standard dressing for the prevention of central-line associated blood stream infection and colonization in Critically Ill Pediatric Patients: A Randomized Controlled Trial

“…Similar outcomes were observed by Levy [25,28]. A recent study involving 192 pediatric patients with non-tunneled CVC reported a CLABSI incidence of 7.9 per 1000 catheter days and found no bene t with the use of CHG-impregnated dressing [38], similar to our ndings. It has also been shown that CHG-impregnated dressing was not effective in reducing catheter infection frequency in tunneled long-term catheters [27].…”

“…The studies by Duzkaya et al and Jitrungruengnij et al did not nd any signi cant decrease in neither CLABSI/CRBSI frequency nor catheter colonization in their respective study groups. [28,38] There are some explanations as to why CHG-impregnated dressing was not effective in reducing the frequency of CLABSI despite its colonization-reducing effect shown in this study. One such explanation is that the limitations in the de nitions of colonization and CLABSI may lead to misdiagnosis of both conditions, which is a potential source of result heterogeneity [19].…”

“…Garland et al reported the overall frequency of contact dermatitis to be 5.7% in their neonatal group, but found that preterm infants weighing less than 1000 grams had a frequency of 15% [26]. In another study which included PICU patients, local AE frequency was reported to be 6.8% and CHG-impregnated dressing was not found to increase AE frequency [38]. Therefore, it appears that, apart from very low-weight preterm infants, CHG-impregnated dressing can be used safely in the neonatal and pediatric age groups.…”

“…In contrast to the wealth of data in adults, there are few studies focused on this topic in the pediatric age group [25][26][27][28]38]. Garland et al, in their study including 705 patients managed in the neonatal intensive care unit, reported that the use of CHG-impregnated disks on the insertion site of non-tunneled catheters did not reduce CRBSI or primary BSI frequency [26].…”

Comparison of chlorhexidine impregnated dressing and standard dressing for the prevention of central‐line associated blood stream infection and colonization in critically ill pediatric patients: A randomized controlled trial

“…25 In another study, which included PICU patients, local AE frequency was reported to be 6.8% and CHGimpregnated dressing was not found to increase AE frequency. 35 It therefore appears that, apart from very lowweight preterm infants, CHG-impregnated dressing can be used safely in the neonatal and pediatric age groups.…”