Chlorhexidine-Impregnated Dressings and Prevention of Catheter-Associated Bloodstream Infections in a Pediatric Intensive Care Unit

Abstract

Background Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates, prolonged hospital lengths of stay, and increased medical costs. oBjectives To compare the effectiveness of chlorhexidine-impregnated dressings with that of standard dressings in preventing catheter-related bloodstream infections. Methods A total of 100 children were randomly divided into 2 groups of 50 each: a chlorhexidine group and a standard group. Patient care was provided in accordance with prevention bundles. Patients were followed up for development of catheter-related bloodstream infections. results Catheter colonization occurred in 4 patients in the standard group (8%) and in 1 patient in the chlorhexidine group (2%). Catheter-related bloodstream infections occurred in 5 patients in the standard group (10%) and in 1 patient in the chlorhexidine group (2%). Although more patients in the standard group had catheter-related bloodstream infections, the difference in infection rates between the 2 groups was not significant (P = .07). conclusions Use of chlorhexidine-impregnated dressings reduced rates of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in a pediatric intensive care unit but was not significantly better than use of standard dressings. (Critical Care Nurse. 2016;36[6]:e1-e7)

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

“…The length of hospital stay, the duration of catheterization, and that of mechanical ventilation were shorter in the former than in the latter group; thus, the reduced CRBSI rate in the CHG-dressing group was considered to be clinically relevant. 13 Although we found no significant between-group difference in the CRBSI rate, no CRBSI caused by a Gram-positive microorganism was noted in the CHG-dressing group.…”

“…Camins et al 12 studying hemodialysis patients with tunneled central venous catheters, found that the CRBSI rate was reduced when CHG dressings were applied. In pediatric patients undergoing central venous catheterization, Düzkaya et al 13 found that the CRBSI rate was lower in a CHG-dressing group than in a standard-dressing group but, again, statistical significance was not attained. The length of hospital stay, the duration of catheterization, and that of mechanical ventilation were shorter in the former than in the latter group; thus, the reduced CRBSI rate in the CHG-dressing group was considered to be clinically relevant.…”

Practice Guidelines for Central Venous Access 2020

“…Pooled estimates from RCTs are consistent with lower rates of catheter colonization with chlorhexidine sponge dressings compared with standard polyurethane (Category A1-B evidence) 90,[133][134][135][136][137][138] but equivocal for catheter-related bloodstream infection (Category A1-E evidence). 90,[133][134][135][136][137][138][139][140] An RCT reports a higher frequency of severe localized contact dermatitis in neonates with chlorhexidine-impregnated dressings compared with povidone-iodine-impregnated dressings (Category A3-H evidence) 133 ; findings concerning dermatitis from RCTs in adults are equivocal (Category A2-E evidence). 90,134,136,137,141 Survey Findings.…”

Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

“…The majority of local reactions were observed in neonates [35], and serious necrotic lesions were reported in very low birthweight (< 1500 g) preterm neonates [255]. Some trials [253,254] showed a tendency towards lower central line-associated bloodstream infection or local infection rates with chlorhexidine-impregnated dressings. However, these decreased rates never reached the statistical significance [35,[253][254][255][256][257].…”