Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better?

Abstract

Background Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings (sponge-dress) and gel dressings (gel-dress) have never been directly compared. We used the data collected for two randomized-controlled trials to perform a comparison between sponge-dress and gel-dress. Methods Adult critically ill patients who required short-term central venous or arterial catheter insertion were recruited. Our main analysis included only patients with CHG-impregnated dressings. The effect of gel-dress (versus sponge-dress) on major catheter-related infections (MCRI) and CRBSI was estimated using multivariate marginal Cox models. The comparative risks of dressing disruption and contact dermatitis were evaluated using logistic mix models for clustered data. An explanatory analysis compared gel-dress with standard dressings using either CHG skin disinfection or povidone iodine skin disinfection. Results A total of 3483 patients and 7941 catheters were observed in 16 intensive care units. Sponge-dress and gel-dress were utilized for 1953 and 2108 catheters, respectively. After adjustment for confounders, gel-dress showed similar risk for MCRI compared to sponge-dress (HR 0.80, 95% CI 0.28–2.31, p = 0.68) and CRBSI (HR 1.13, 95% CI 0.34–3.70, p = 0.85), less dressing disruptions (OR 0.72, 95% CI 0.60–0.86, p < 0.001), and more contact dermatitis (OR 3.60, 95% CI 2.51–5.15, p < 0.01). However, gel-dress increased the risk of contact dermatitis only if CHG was used for skin antisepsis (OR 1.94, 95% CI 1.38–2.71, p < 0.01). Conclusions We described a similar infection risk for gel-dress and sponge-dress. Gel-dress showed fewer dressing disruptions. Concomitant use of CHG for skin disinfection and CHG-impregnated dressing may significantly increase contact dermatitis. Trials registration These studies were registered within ClinicalTrials.gov (numbers NCT01189682 and NCT00417235).

Chlorhexidine-dress related contact dermatitis—the precautionary principle is no more relevant!

“…We read carefully the Buetti et al [1] post hoc analysis of two open randomized multicenter French studies, comparing non-disinfectant dressings with CHG-releasing sponge (December 2006 to May 2008) [2] and with CHG-releasing gel (May 2010 to July 2011) [3].…”

“…After adjustment for confounders, gel-dress showed similar risk for MCRI compared to sponge-dress (HR 0.80 Alcoholic-CHG was used for skin preparation in 1533 of gel-dress recipients (72.7%) and only 20 patients with sponge-dress (1.3%) [1]. In a recently published realworld evidence study, the gel-dress was applied with CHG for skin antisepsis [4].…”

“…We read carefully the Buetti et al [ 1 ] post hoc analysis of two open randomized multicenter French studies, comparing non-disinfectant dressings with CHG-releasing sponge (December 2006 to May 2008) [ 2 ] and with CHG-releasing gel (May 2010 to July 2011) [ 3 ]. After adjustment for confounders, gel-dress showed similar risk for MCRI compared to sponge-dress (HR 0.80, 95% CI 0.28–2.31, p = 0.68) and CRBSI (HR 1.13, 95% CI 0.34–3.70, p = 0.85), less dressing disruptions (OR 0.72, 95% CI 0.60–0.86, p < 0.001), and more contact dermatitis (OR 3.60, 95% CI 2.51–5.15, p < 0.01).…”

“…Alcoholic solutions of CHG have demonstrated superior efficacy in prevention of infections complications and graded IA by CDC Guidelines [ 5 ]. Supported by two randomized studies [ 1 , 2 ] and confirmed by a real-world study [ 4 ], the use of CHG-dressings to reduce CRBSI is also a IA scored recommendation [ 5 ].…”

Development of central venous access device‐associated skin impairment assessment instrument

“…Although the scoring system consisted of four levels, it can only assess skin redness, swelling, blisters and a spreading reaction (Timsit et al., 2009 ). This scoring system was also used in subsequent skin condition assessments by other investigators (Buetti et al., 2020 ; Günther et al., 2016 ; Mimoz et al., 2015 ; Timsit et al., 2012 ), but there were some limitations, such as less detailed and ordinal response format to report the size of blisters. In other studies, unvalidated local institutional grading was used to assess skin status (Curtis et al., 2015 ; Su et al., 2017 ).…”