Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years

Abstract

Background Prospective randomized controlled studies have demonstrated that addition of chlorhexidine (CHG) dressings reduces the rate of catheter (central venous and arterial)-associated bloodstream infections (CABSIs). However, studies confirming their impact in a real-world setting are lacking. Methods We conducted a real-world data study evaluating the impact of incrementally introducing chlorhexidine dressings (sponge or gel) in addition to an ongoing catheter bundle on the rates of CABSI, expressed as incidence density rates per 1000 catheter-days measured as part of a surveillance program. Poisson regression models were used to compare infection rates over time. Both dressings were used simultaneously during one of the five study periods. Results From 2006 to 2014, 18,286 patients were admitted (91,292 ICU-days and 155,242 catheter-days). We recorded 111 CABSIs. We observed a progressive but significant decrease of CABSI rates from 1.48 (95% CI 1.09–2.01) without CHG dressings to 0.69 (95% CI 0.43–1.09) and 0.23 (95% CI 0.11–0.48) episodes per 1000 catheter-days when CHG sponge and CHG gel dressings were used ( p = 0.0007; p < 0.001). A non-significant lower rate of infections occurred with CHG gel compared with CHG sponge dressings. An identical low rate of allergic skin reactions (0.3/1000 device-days) was observed with both types of CHX dressings. Post-study data until 2018 confirmed a sustained decrease of infection rates over 11 years. Conclusions The addition of chlorhexidine dressings to all CVC and arterial lines to an ongoing catheter bundle was associated with a sustained 11-year reduction of all catheter-associated bloodstream infections. This large real-world data study further supports the current recommendations for the systematic use of CHG dressings on all catheters of ICU patients. Electronic supplementary material The online version of this article (10.1007/s00134-019-05617-x) contains supplementary material, which is available to authorized users.

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

“…CHX-impregnated dressings were tested in cancer and ICU patients in randomized trials showing a reduction in CRI rates compared with standard dressings, and this finding could be confirmed in a recent systematic review and meta-analysis [31, [144][145][146][147][148]. A recent multicenter randomized trial studied the use of dressings containing CHX-containing gel pads compared with standard non-impregnated dressings in 613 neutropenic cancer patients using the stringent definition of definite CRBSI and probable CRBSI [10,31].…”

ECLS-associated infections in adults: what we know and what we don’t yet know

“…For example, 97% of patients in the previously mentioned cohort of immunocompromised patients were receiving antibiotics before ECLS, despite in many cases not having an infectious etiology for their respiratory failure [6]. Other infection prevention practices, including cannula maintenance strategies, vary across centers [46,50]. Many of the recommendations put forth by ELSO, such as the use of sterile techniques, adherence to VAP prevention guidelines, and avoidance or removal of unnecessary invasive devices, mirror general infection prevention practices followed in critically ill patients (Fig.…”

Perfil microbiológico da colonização do sítio de inserção do cateter venoso central considerando dois curativos transparentes

“…A maioria dos achados da literatura em relação ao CGCHX tratam da sua capacidade de redução de infecção de corrente sanguínea relacionada ao cateter ou redução de colonização do CVC 4,9,10,[13][14][15][16][17][18][19][20] .…”