Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized controlled trial

Chambers, Stephen T.; Sanders, Joanne M.; Patton, W. N.; Ganly, Peter; Birch, M.; Crump, John A.; Spearing, Ruth

doi:10.1016/j.jhin.2005.01.023

Cited by 59 publications

(71 citation statements)

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“…In a population of 50 surgical patients, Hanazaki et al [14] found a marked reduction in exit-site colonizations; unfortunately, the duration of catheterization was not given, and rates of CRI were not investigated in that study. Maki et al [15] presented a [16]. In a recent meta-analysis [17], eight studies on epidural catheters and CVCs in paediatric and adult patients were analysed.…”

Section: Discussionmentioning

confidence: 99%

Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial

et al. 2008

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The objective of the study was to evaluate the effectiveness of chlorhexidine-impregnated sponges for reducing catheter-related infections of central venous catheters inserted for cancer chemotherapy. The method used was a randomized, prospective, open, controlled clinical study (three-step group sequential analysis protocol). The patients were from two high dependency units at a university hospital undergoing chemotherapy for haematological or oncological malignancies requiring central venous catheters (CVCs) expected to remain in place for at least 5 days. Six hundred and one patients with 9,731 catheterization days were studied between January 2004 and January 2006. Patients admitted for chemotherapy received chlorhexidine and silver sulfadiazine-impregnated triple-lumen CVCs under standardized conditions and were randomized to the groups receiving a chlorhexidine gluconate-impregnated wound dressing or a standard sterile dressing. Daily routine included clinical assessment of the insertion site (swelling, pain, redness), temperature, white blood count and C-reactive protein. Catheters remained in place until they were no longer needed or when a CVCrelated infection was suspected. Infection was confirmed with blood cultures via the catheter lumina and peripheral blood cultures according to the time-to-positivity method. Six hundred and one patients were included. The groups were comparable with respect to demographic and clinical data. The incidence of CVC-related infections were 11.3% (34 of 301) and 6.3% (19 of 300) in the control and chlorhexidine-impregnated wound dressing groups, respectively (p=0.016, relative risk 0.54; confidence interval 0.31-0.94). Especially, catheter-related infections at internal jugular vein insertions could be reduced (p=0.018). No adverse effects related to the intervention were observed. The use of chlorhexidine-impregnated wound dressings significantly reduced the incidence of CVC-related infections in patients receiving chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial

et al. 2008

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“…Although exit site infections were significantly reduced in the chlorhexidine-impregnated disc group (16% reduction, p<0.05), CRBSIs were non-significantly reduced (4% reduction, p>0.05). Chambers et al (2005) performed a randomized controlled trial in neutropenic oncology adult patients (n = 114 catheters) receiving chemotherapy via tunneled CVCs. This study only evaluated the proportion of patients acquiring exit site infections and tunnel infections.…”

Section: Effectiveness Of Chlorhexidine-impregnated Discs In Hospitalmentioning

confidence: 99%

Antimicrobial-Impregnated Discs for Prevention of Intravenous Catheter-Related Infections

Daniels

Frei²

2012

American Journal of Infectious Diseases

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Problem statement: Healthcare-associated infections are the 5th leading cause of death in the United States. Catheter-Related Bloodstream Infections (CRBSIs) comprise 14% of all healthcareassociated infections and contribute to increased mortality and financial costs. Antimicrobialimpregnated sponge discs to be used surrounding the catheter insertion site are a newer addition to the options available for the prevention of catheter-related infections. Approach: This review critically appraises the literature regarding the utility of antimicrobial-impregnated discs. We performed a literature search using the MEDLINE (1948-November 2011) database. Only controlled clinical trials were included and the electronic database search was performed using the following MeSH and keyword search terms: ("Biopatch" or "chlorhexidine") and ("dressing" or "sponge") and ("catheter"). Results: Our search yielded eight trials. Chlorhexidine-impregnated discs are effective in preventing catheter colonization in hospitalized patients and outpatients; however, effectiveness in preventing CRBSIs may be limited to hospitalized, critically ill patients. Although many studies have evaluated the effectiveness of several pharmaceutical agents for the prevention of catheter-related infections, there are still significant gaps in the literature regarding these infections, including the effectiveness of Polyhexamethylene Biguanide (PHMB)-impregnated discs and the cost-effectiveness of PHMBimpregnated discs compared to chlorhexidine-impregnated discs. It is also unclear if antimicrobialimpregnated discs are effective in specific populations, like in outpatients, patients at high risk compared to low risk patients and patients with long-term catheters. Conclusion: Chlorhexidineimpregnated discs should be utilized for the duration of catheterization in high risk, critically ill patients and in hospitals where catheter-related infection rates are persistently high despite other preventative strategies. Futher investigation of the effectiveness of these discs in other populations and of other antimicrobial-impregnated discs is needed.

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“…Antes dessas publicações, os ensaios clínicos haviam testado o curativo de CHG com esponja em forma de disco (CHAMBERS et al, 2005;RUSCHULTE et al, 2009;TIMSIT et al, 2009TIMSIT et al, , 2012a 2012;TIMSIT et al, 2009TIMSIT et al, , 2012aTIMSIT et al, , 2012b …”

Section: Revisão Da Literaturaunclassified

Ensaio clínico randomizado do uso do curativo gel de clorexidina para a prevenção da colonização do cateter venoso central em pacientes adultos críticos

Margatho¹

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, minha amiga, minha mãe e minha orientadora, você foi muito importante no meu caminho. Durante a graduação me ensinou a ser enfermeira e amar cada vez minha profissão. Hoje após 13 tantos anos me ensinou o caminho da pesquisa, você é uma excelente pesquisadora, professora e orientadora. Que você nunca deixe de ser um grande exemplo para quem está ao seu lado. Agradeço com todo meu coração a confiança depositada em mim "foi o tempo que dedicasse a tua rosa que fez tua rosa tão importante".Profª Dra. Carla Regina com você aprendi o dom de ensinar, de respeitar e amar quem está ao redor. Você é minha amiga de fé e de joelho no chão. Tive a sorte de dividir momentos da minha vida com você.Prof Dra. Marcia Ciol "Statistics without science is incomplete, Science without statistics is imperfect." Muito além dos números e análises estatísticas, aprendi com você uma nova forma de olhar e viver a vida. Você me mostrou valores muito bons e verdadeiros. Sem você no meu caminho eu seria incompleta. Obrigada por toda nossa caminhada.Paula Diniz você foi um grande presente que a vida me deu, sempre me ensina a ser pesquisadora e professora. Com muita alegria e risadas você me mostra que a vida é simples e cheia de encantamentos. Obrigada por sempre buscar o meu melhor e me mostrar esse caminho. Sua parceria e apoio são importantes no meu caminho. Os acessos venosos são indispensáveis para assistência do paciente em situação crítica. O cateter venoso central (CVC) é um acesso que viabiliza a terapêutica dessa clientela, mas o seu uso pode levar à infecções. Estas infecções ocasionam maior permanência hospitalar, elevam os custos totais das instituições e aumentam a morbidade e a mortalidade do paciente. O uso de curativos como cobertura do sítio de saída do CVC é eficaz na prevenção das infecções relacionadas a estes cateteres, em particular, o uso de curativos impregnados com antissépticos como o curativo gel de clorexidina. Este estudo teve como objetivo comparar a efetividade do curativo gel de clorexidina com a do filme transparente de poliuretano na prevenção da colonização do cateter venoso central em pacientes adultos críticos. Trata-se de estudo experimental, do tipo ensaio clínico randomizado, com tratamentos em paralelo, prospectivo e monocêntrico, realizado de acordo com as recomendações do Consolidated Standards of Reporting Trials (CONSORT). O estudo foi realizado na Unidade de Terapia Intensiva e na Unidade Coronariana de um hospital de ensino do interior do Estado de São Paulo. Participaram do estudo 102 indivíduos hospitalizados nestes locais, divididos aleatoriamente em dois grupos: grupo intervenção, no qual o tipo de cobertura utilizada foi o curativo de gel de clorexidina e grupo controle, que utilizou como cobertura o filme transparente de poliuretano. O desfecho primário mensurado foi a colonização do cateter e os desfechos secundários foram a infecção clínica do sítio de saída, a infecção microbiológica do sítio de saída e a infecção da corrente sanguínea relacionada ao cateter. Para a coleta de dados fo...

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Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized controlled trial

Cited by 59 publications

References 23 publications

Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial

Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial

Antimicrobial-Impregnated Discs for Prevention of Intravenous Catheter-Related Infections

Ensaio clínico randomizado do uso do curativo gel de clorexidina para a prevenção da colonização do cateter venoso central em pacientes adultos críticos

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