Abstract
Problem statement: Healthcare-associated infections are the 5th leading cause of death in the United States. Catheter-Related Bloodstream Infections (CRBSIs) comprise 14% of all healthcare-associated infections and contribute to increased mortality and financial costs. Antimicrobial-impregnated sponge discs to be used surrounding the catheter insertion site are a newer addition to the options available for the prevention of catheter-related infections. Approach: This review critically appraises the literature regarding the utility of antimicrobial-impregnated discs. We performed a literature search using the MEDLINE (1948-November 2011) database. Only controlled clinical trials were included and the electronic database search was performed using the following MeSH and keyword search terms: (“Biopatch” or “chlorhexidine”) and (“dressing” or “sponge”) and (“catheter”). Results: Our search yielded eight trials. Chlorhexidine-impregnated discs are effective in preventing catheter colonization in hospitalized patients and outpatients; however, effectiveness in preventing CRBSIs may be limited to hospitalized, critically ill patients. Although many studies have evaluated the effectiveness of several pharmaceutical agents for the prevention of catheter-related infections, there are still significant gaps in the literature regarding these infections, including the effectiveness of Polyhexamethylene Biguanide (PHMB)-impregnated discs and the cost-effectiveness of PHMB-impregnated discs compared to chlorhexidine-impregnated discs. It is also unclear if antimicrobial-impregnated discs are effective in specific populations, like in outpatients, patients at high risk compared to low risk patients and patients with long-term catheters. Conclusion: Chlorhexidine-impregnated discs should be utilized for the duration of catheterization in high risk, critically ill patients and in hospitals where catheter-related infection rates are persistently high despite other preventative strategies. Futher investigation of the effectiveness of these discs in other populations and of other antimicrobial-impregnated discs is needed.
Highlights
Catheters contribute to an estimated 250,000 nosocomial catheter-related bloodstream infections (CRBSIs) annually in the United States (U.S.) (Klevens et al, 2007)
Ruschulte et al (2009) performed a large trial evaluating the effectiveness of chlorhexidineimpregnated discs for the prevention of catheter-related infections
Catheter colonization CRBSIs
Summary
Catheters contribute to an estimated 250,000 nosocomial catheter-related bloodstream infections (CRBSIs) annually in the United States (U.S.) (Klevens et al, 2007). Contaminant in cultures of suspected CRBSIs; of patients who used chlorhexidine-impregnated discs it is believed to be a legitimate cause of CRBSIs. surrounding the catheter site; 0.2% in adults and 5.4%. For this reason, stricter diagnostic criteria are applied to in infants and neonates. The discs provide a longer duration of action, providing up to seven days of antimicrobial action compared to approximately 24 h with skin antisepsis alone (McGhee et al, 2009) This of evaluating the effectiveness of chlorhexidineimpregnated discs in reducing catheter colonization and CRBSIs. Hospitalized patients were included if they were catheterized with a central venous, pulmonary artery, or peripheral catheter. The authors concluded that the use of the chlorhexidine-impregnated discs reduced the risk of catheter colonization and CRBSIs in hospitalized patients
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