Chlorhexidine locking device for central line infection prevention in ICU patients: protocol for an open-label pilot and feasibility randomized controlled trial

Abstract

Background Critically ill patients in the intensive care unit (ICU) are at risk for central line-associated bloodstream infection (CLABSI) with an incidence up to 6.9 per 1000 catheter days. CLABSI has a significant attributable mortality and increases in-hospital length of stay, readmissions, and costs. Chlorhexidine gluconate (CHG), a broad-spectrum biocide, has been shown to effectively reduce infections including CLABSI; however, few trials have utilized CHG for prevention of central line infections. Our preclinical work has demonstrated a device that diffuses CHG into the intravenous lock solution of central venous catheters and decreases bacterial growth on the catheter lumen. We designed a clinical trial to test the feasibility of using a CHG device in an ICU patient population. Methods The proposed pilot trial will be a single centre, open-label, two-arm, parallel group feasibility randomized controlled trial (RCT). Participants will have a central line in situ and will be enrolled within 72 h of admittance to 3 ICUs at a single academic hospital. Exclusion criteria will include suspected infection, chronic indwelling catheters, and CHG allergy. Informed consent will be obtained from eligible participants or their substitute decision maker prior to randomization. Participants will be randomized to receive either usual care or the CHG locking device. Blood cultures will be drawn from all participants every 48 h. The primary objective of this study will be to determine the feasibility of using this protocol to conduct a larger trial. Feasibility will be assessed through the following outcomes: (1) consent rate, (2) recruitment rate, (3) protocol adherence, and (4) comfort level with the device. The secondary objective of this study will be to establish the preliminary efficacy of the device. Discussion This study will be the first human RCT to investigate a CHG locking device for the prevention of central line infections. Findings from this trial will inform the feasibility of conducting a large RCT and provide preliminary data on the efficacy of a CHG locking device. Trial registration ClinicalTrials.gov, NCT03309137, registered on October 13, 2017.

Locking solutions for prevention of central venous access device complications in the adult critical care population: A systematic review

“…Of these papers, 6 were deemed eligible to move on to the final stage of quality appraisal. Results of this original search also included one study protocol [ 32 ] which was excluded at that time as per exclusion criteria. Published results [ 33 ] were included in the final quality appraisal following their publication in 2022.…”

Chlorhexidine (di)gluconate locking device for central line infection prevention in intensive care unit patients: A multi-unit, pilot randomized controlled trial

“…A detailed protocol describing the study methods was published and is publicly accessible (Zamir et al, 2020).…”

“…Participants allocated to the CHGLS group received a set volume of CHG in the catheter lumens in addition to usual care. Venous catheters that were not infusing were maintained with the addition of a pre-specified volume of CHG solution (see video and description previously published; Zamir et al, 2020). This was achieved by attaching a sterile CHG adapter onto a sterile saline syringe and pushing a pre-specified volume (indicated by the type of lumen) of CHG-infused solution into the catheter lumen (Zamir et al, 2020).…”

“…Prior to the study start-up, clinical staff were educated on the protocol, device, and intervention. Educational activities included group and one-to-one staff training sessions, onepage handouts circulated within the ICU, and an accessible video detailing the study protocol (Zamir et al, 2020). Two nurse champions were identified to provide support to bedside staff.…”