Central‐line‐associated bloodstream infections in a surgical paediatric intensive care unit: Risk factors and prevention with chlorhexidine bathing

Abstract

Aim The aims of the study are to evaluate the impact of a 4% chlorhexidine (CHG4%) bathing on the occurrence of central‐line‐associated bloodstream infection (CLABSI) and to identify risk factors (RFs) for CLABSI in our population. This is a retrospective monocentric cohort study in the paediatric surgical intensive care unit at the Necker Enfants Malades Hospital, Paris, France. Methods All hospitalised patients with central venous catheters (CVCs) in 2015 were included. CHG4% bathing was prescribed in CLABSI high‐risk patients, defined by the presence of exposition factors (EFs): constitutive or acquired immunosuppression, presence of an invasive medical device (IMD) and the carriage of Staphylococcus aureus. The overall 2015 CLABSI incidence rate was compared with 2014 CLABSI incidence rate (before CHG4% bathing). Results In all, 775 patients were analysed. Some 182 had at least one EF, and 49 received CHG4%. The incidence rates of CLABSI in 2014 and 2015 were, respectively, 6.1 and 2.3/1000 days CVC (P < 0.01). The presence of at least one EF was associated with the CLABSI's occurrence: odds ratio = 15.13 (95% confidence interval: 4.26–53.71; P < 0.0001), particularly acquired immunosuppression, IMD and S. aureus colonisation. Other RFs were age <1 year and carrying duration >16 days. Conclusions This study showed a significant reduction in incidence of CLABSI after introduction of a targeted CHG4% bathing protocol. Presence of IMD, S. aureus colonisation, immunosuppression, age <1 year and carrying duration >16 days were CLABSI RFs. Regarding the literature, the presence of IMD seems to be underestimated in CLABSI prevention.

Effectiveness of Chlorhexidine-Impregnated Central Venous Catheter Dressing for Preventing Catheter-Related Bloodstream Infections in Pediatric Patients: A Systematic Review and Meta-Analysis Study

“…1,3,5,8 However, it is believed that 65 to 70% of CRBSIs might be prevented. 9 One of the most important steps in the prevention of CRBSIs is nursing practices. 3 The care of CVCs falls within the direct and ongoing purview of nurses.…”

“…Numerous studies have shown how efficient it is at preventing CRBSIs in different ways. 9 15 16 The usefulness of chlorhexidine-impregnated (C-I) dressings as a barrier for bacterial penetration to the CVC insertion site and the efficacy of chlorhexidine in decreasing bioburden within the dressing during usage have been proven by the U.S. Food and Drug Administration. 15 In accordance with recent recommendations, patients who are 18 years of age or older should use C-I dressings to protect the location where CVCs are inserted.…”