Chlorhexidine bathing of the exposed circuits in extracorporeal membrane oxygenation: an uncontrolled before-and-after study

Hye Ju Yeo,Mihyang Ha,Woo Hyun Cho,Jeong Soo Kim,Hyung Gon Je,Dohyung Kim

doi:10.1186/s13054-020-03310-w

Hye Ju Yeo, Mihyang Ha + Show 4 more

Open Access

https://doi.org/10.1186/s13054-020-03310-w

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Abstract

BackgroundAlthough the prevention of extracorporeal membrane oxygenation (ECMO) catheter-related infection is crucial, scientific evidence regarding best practices are still lacking.MethodsWe conducted an uncontrolled before-and-after study to test whether the introduction of disinfection with 2% chlorhexidine gluconate (CHG) and 70% isopropyl alcohol (IPA) of the exposed circuits and hub in patients treated with ECMO would affect the rate of blood stream infection (BSI) and microbial colonization of the ECMO catheter. We compared the microbiological and clinical data before and after the intervention.ResultsA total of 1740 ECMO catheter days in 192 patients were studied. These were divided into 855 ECMO catheter days in 96 patients before and 885 ECMO catheter days in 96 patients during the intervention. The rates of BSI were significantly decreased during the intervention period at 11.7/1000 ECMO catheter days before vs. 2.3/1000 ECMO catheter days during (difference 9.4, 95% confidence interval (CI) 1.5–17.3, p = 0.019). Furthermore, the colonization of the ECMO catheter was similarly significantly reduced during the intervention period at 10.5/1000 ECMO catheter days before vs. 2.3/1000 ECMO catheter days during intervention (difference 8.3, 95% CI 0.7–15.8, p = 0.032). Hospital mortality (41.7% vs. 24%, p = 0.009) and sepsis-related death (17.7% vs. 6.3%, p = 0.014) were also significantly decreased during intervention.ConclusionExtensive disinfection of exposed ECMO circuits and hub with 2% CHG/IPA was associated with a reduction in both BSI and microbial colonization of ECMO catheters. A further randomized controlled study is required to verify these results.Trial registrationKCT 0004431

Highlights

The prevention of extracorporeal membrane oxygenation (ECMO) catheter-related infection is crucial, scientific evidence regarding best practices are still lacking
It was found that 19–32% of inserted ECMO catheters were colonized with potentially pathogenic bacteria at the point of removal and that about 10% were associated with ECMO device infection [1, 2]
We investigated whether disinfection with 2% chlorhexidine gluconate (CHG)/isopropyl alcohol (IPA) of all exposed circuits and hubs impacts on the rate of blood stream infection (BSI) and ECMO catheter colonization

Summary

Introduction

The prevention of extracorporeal membrane oxygenation (ECMO) catheter-related infection is crucial, scientific evidence regarding best practices are still lacking. Extracorporeal membrane oxygenation (ECMO) is increasingly being used worldwide to save patients with severe cardiorespiratory failure. Depending on the patient’s condition, ECMO treatment may last several days or longer, but its presence is a major risk factor for blood stream infection (BSI). It was found that 19–32% of inserted ECMO catheters were colonized with potentially pathogenic bacteria at the point of removal and that about 10% were associated with ECMO device infection [1, 2]. Manipulation of hub for the use of renal replacement therapy (RRT) during ECMO, or for oxygenator function test, and exchange of oxygenator or catheters potentially pose a risk of BSI

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