Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms

Abstract

Objective:We compared the protective effects of secure Chlorhexidine Gluconate (CHG)-containing dressings with those of non-antimicrobial transparent dressings.Methods:This prospective, comparative, single-center clinical study was conducted in a tertiary pediatric intensive care unit from October 2014 to March 2017. The inclusion criterion was catheterization of the jugular vein for ≥48 hour. The study was conducted in two phases. Non-antimicrobial standard dressings were applied both before and after the CHG- dressing phase to negate any coincidental temporal effect. During the standard-dressing phases, the dressings did not include any antimicrobial; transparent CHG-impregnated dressings were applied during the test phase. All patients were divided into two groups by the type of dressing applied (standard and CHG-containing dressings).Results:The standard- and CHG-dressing groups contained 68 and 63 patients, respectively. The median durations of catheterization were 13 (8–22) and 14 (2–28) days, respectively (p>0.05). The Catheter-Related Bloodstream Infection (CRBSI) rate was somewhat lower in the CHG-dressing group (20.6 vs. 26.5%), but the difference was not statistically significant (p>0.05). In the CHG-dressing group, CRBSIs caused by Gram-positive microorganisms totaled 0%, but the figure was 8.8% in the control group (p=0.028).Conclusions:CHG dressings reduced CRBSIs caused by Gram-positive microorganisms.

Effectiveness of chlorhexidine dressings to prevent catheter-related bloodstream infections. Does one size fit all? A systematic literature review and meta-analysis

“…Table 1 and Appendix 3 (online) present the characteristics of included studies. The selected studies included 18 RCTs 19-36 and 2 quasi-experimental studies, 37,38 and all of them were performed in hospital settings. Furthermore, 6 studies were multicentric (≥ 2 hospitals), [19][20][21][22][23]27 14 studies were performed on adults, [20][21][22][23][24][25][27][28][29]31,[33][34][35]38 and 6 studies examined neonates or pediatric populations.…”

“…Furthermore, 6 studies were multicentric (≥ 2 hospitals), [19][20][21][22][23]27 14 studies were performed on adults, [20][21][22][23][24][25][27][28][29]31,[33][34][35]38 and 6 studies examined neonates or pediatric populations. 19,26,30,32,36,37 Of the studies with this information, 13 included ICU patients, 19,[21][22][23][24][25][26]29,32,[34][35][36][37] 4 included onco-hematological patients, 27,30,31,33 and 1 included non-ICU patients. 28 The definition of CRBSI, exit-site and tunnel infections, and adverse events varied across the studies (Appendix 4 online).…”

“…Among studies with available data, 11 included short-term CVCs, 21,[24][25][26][27]29,32,33,[35][36][37] 3 included long-term CVCs, 30,31,38 3 included CVCs and arterial catheters, 20,22,23 1 included long and short-term CVCs, 19 and 1 included PICC lines. 28 In addition, 2 studies used antimicrobial-impregnated catheters.…”

“…24 Also, 3 studies used >0.5% of CHG skin preparation before catheter insertion. 28,35,37 Maximal sterile barrier precautions were cited in 14 studies. 19,[21][22][23][24][25][26]29,30,[32][33][34][35][36]…”

“…In the intervention group, 10 studies used CHG discs (Biopatch) [19][20][21][22]28,[31][32][33][34]38 , 8 used CHG transparent dressings (Tegaderm or unspecified), [23][24][25]27,30,[35][36][37] and 2 used "CHGimpregnated dressings" without further detail. 26,29 In the control group, 16 studies used transparent dressings, [19][20][21][22][23][24][25]27,28,30,[32][33][34][35][36][37] 2 used gauzes, 26,29 1 used standard-of-care dressings, 38 and 1 did not use dressings. 31 Most studies planned a 7-day dressing change for the CHG group (n = 13).…”