Chlorhexidine-impregnated Dressings Research Articles

Impact of a 'Catheter Bundle' on Infection Rates and Economic Costs in the Intensive Care Unit: A Retrospective Cohort Study.

Catheter-related infections (CBRSIs) are a widespread problem that increase morbidity and mortality in intensive care unit (ICU) patients and management costs. The main aim of this study was to assess the prevalence of CBRSIs in an intensive care unit following international literature guidelines for managing vascular lines in critically ill patients. These guidelines include changing vascular lines every 7 days, using needle-free devices and port protectors, standardising closed infusion lines, employing chlorhexidine-impregnated dressings, and utilising sutureless devices for catheter securement. This single-centre retrospective observational study was conducted in a general Italian ICU. This study included all eligible patients aged > 1 year who were admitted between January 2018 and December 2022. During the study period, 1240 patients were enrolled, of whom 9 were diagnosed with a CRBSI. The infection rate per 1000 catheters/day was as follows: femorally inserted central catheter, 1.04; centrally inserted central catheter, 0.77; pulmonary arterial catheter 0.71, arterial catheter, 0.1; and peripherally inserted central catheter and continuous veno-venous haemodialysis dialysis catheters equal to 0. No difference in CRBSI was observed between the years included in the study (p = 0.874). The multivariate analysis showed an association between the diagnosis of CBRSI and Nursing Activities Score (per single point increase β = 0.04-95%CI: -0.01-0.09, p = 0.048), reason for ICU admission-trauma (β = 0.77-95%CI: -0.03-1.49, p = 0.039), and use of therapeutic hypothermia (β = 2.06, 95%CI: 0.51-3.20, p < 0.001). Implementing the study protocol revealed a cost of EUR 130.00/patient, equivalent to a daily cost of EUR 15.20 per patient. This study highlights the importance of implementing a catheter care bundle to minimise the risk of CRBSI and the associated costs in the ICU setting. A policy change for infusion set replacement every 7 days has helped to maintain the CRBSI rate below the recommended rate, resulting in significant cost reduction and reduced production of ICU waste.

Effectiveness of a multimodal strategy to reduce external ventricular drain–associated infection: A quasi-experimental study

Infection is a serious complication in neurosurgical patients who undergo external ventricular drain (EVD) insertion. We conducted a quasi-experimental study in patients who underwent EVD insertion to evaluate the impact of a multi-modal strategy to reduce the incidence of external ventricular drain associated infections (EVDAIs). The study was divided into 2 periods; (1) the pre-intervention period when techniques for EVD insertion and maintenance were up to the discretion of the neurosurgeons and (2) the post-intervention after implementation of a multi-modal strategy (cefazolin antibiotic prophylaxis, preoperative chlorhexidine showers, application of postoperative chlorhexidine-impregnated dressing, limited manipulation of the EVD, and meticulous EVD management). The primary outcome was the incidence rate of EVDAIs; secondary outcomes included in-hospital mortality rate, the hospital length of stay. In total, 135 patients were included. The incidence rate of EVDAIs was significantly reduced in the post-intervention period (5.6 cases/1,000 EVD-days) compared with the pre-intervention period (18.2 cases/1,000 EVD-days; P=0.026). There were no differences in all secondary outcomes analyzed. This multi-modal strategy was associated with high satisfaction among health care personnel. Implementation of a multi-modal strategy was associated with a reduction in the incidence of EVDAIs. This was in line with our goal of promoting a new culture of safety despite being in a resource-limited setting.

Use of chlorhexidine-impregnated dressings and early catheter exchange to reduce the onset of central line-associated bloodstream infections: A case-control study in a cardiac intensive care unit

Use of chlorhexidine-impregnated dressings and early catheter exchange to reduce the onset of central line-associated bloodstream infections: A case-control study in a cardiac intensive care unit

Effectiveness of Chlorhexidine-Impregnated Central Venous Catheter Dressing for Preventing Catheter-Related Bloodstream Infections in Pediatric Patients: A Systematic Review and Meta-Analysis Study

Abstract Objective The study's objective was to use meta-analysis to assess the effectiveness of a dressing impregnated with chlorhexidine in preventing catheter-related bloodstream infections (CRBSIs) in pediatric patients. Methods The study was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A comprehensive search of 18 databases was conducted up to 5 March 2020 to identify related studies. Following the evaluation of the methodological quality, 8 studies, 1,584 catheters in 1,556 patients were added to the meta-analysis. The odds ratio and Hedge's G effect size value were employed to analyze the data. Either a fixed-effects model or a random-effects model was used to compute the effect size value with 95% confidence intervals (CIs). The heterogeneity of effect sizes was investigated using Cochrane Q statistics, I 2, and Tau2 tests. To test for publication bias, funnel plot, Orwin's safe n number, Begg and Mazumdar rank correlation, Egger test, and Duval and Tweedie's trim and fill procedures were all utilized. Results The catheter colonization risk was lowered by 50.7% by the chlorhexidine-impregnated (C-I) dressing (odds ratio [OR] = 0.493 [%95 CI: 0.360–0.675]; p &lt; 0.001). The use of C-I dressing was associated with a trend toward a decrease in CRBSIs, while this association was not statistically significant (OR = 0.858 [%95 CI: 0.567–1.300]; p = 0.471). Conclusion The use of C-I dressing can effectively reduce the risk of catheter colonization, and it is also a helpful tactic in lowering CRBSIs in pediatric patients with central venous catheters, according to the findings of this meta-analysis.

Study of the effectiveness of antimicrobial dressings with chlorhexidine bigluconate in the prevention of catheter-related blood-stream infections in pediatric intensive care units

Introduction. Nosocomial infections are risk factors associated with in-hospital mortality. Among other factors, these infections are strongly associated with invasive devices. In pediatric patients, a central venous catheter (CVC) is one of the most common causes of catheter-related bloodstream infection (CRBSI).&#x0D; Background. To investigate the effectiveness of antimicrobial chlorhexidine dressings compared with standard dressings in the prevention of central venous catheter-related bloodstream infections.&#x0D; Methods. 20 children who were treated in the intensive care unit were randomly divided into two groups of 10: a group that used chlorhexidine dressings and a group that used standard dressings (comparison group). Patient care was carried out in accordance with asepsis and antisepsis rule. The primary outcomes were a comparative study of microbiological researches of peripheral blood blood culture and catheter blood sample. But the final results were cultures from the tip of the catheter (at least 5 cm) after removal of the catheter in case of clinical symptoms of KAIK or in case of planned removal of the catheter due to the lack of its further need.&#x0D; Results. Catheter colonization occurred in 3 patients in the control group (3 %) and in 2 patients in the chlorhexidine dressing group (2 %). Catheter-related bloodstream infections occurred in 3 patients in the control group (3%), and in patients in the chlorhexidine group, no microorganisms were isolated by microbiological examination of the implantation sites (0 %). Although more patients in the comparison group had catheter-related bloodstream infections, the difference in infection rates between the two groups was insignificant (P = 0.07).&#x0D; Conclusions. The use of chlorhexidine-impregnated dressings reduced the incidence of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in the pediatric intensive care unit, but there was no significant difference compared with the use of standard dressings. This study needs further study in pediatric patients.

Chlorhexidine-impregnated Tulle Gras Versus Polyethylene Nonadhesive Film for Dressing of Donor Site Wounds in Cases of Split-thickness Skin Graft

Introduction. Restoration of an intact skin barrier is of utmost importance to prevent infection and wound contractures. Skin grafting is a rapid, effective method of wound coverage. The chief goal of management of the donor area is to achieve early epithelialization without infection. The donor areas need optimum local care to achieve this goal with minimal pain and in a cost-effective manner. Objective. This study compared nonadhesive polyethylene dressings with chlorhexidine-impregnated tulle gras dressings for donor areas. Material and Methods. This was a prospective, randomized, observational study in a tertiary hospital and included 60 patients with posttraumatic, postinfective, or burn wounds. Patients were randomized into 2 groups to receive either chlorhexidine-impregnated tulle gras or polyethylene film for donor area coverage. The pain score, comfort score, completeness of epithelialization, and sequelae were studied in both groups. Results. Patients in the polyethylene film group showed a significantly better comfort score and reduced pain on day 14 as compared with the chlorhexidine group. Time to complete epithelialization was similar in both groups. Conclusions. Polyethylene nonadhesive film dressing is a low-cost, inert, safe, and easily available alternative for donor area dressing and is superior to chlorhexidine-impregnated tulle gras in terms of pain and comfort.

774. Outbreak of Central-Line-Associated Bloodstream Infections (CLABSI) amid the COVID-19 Pandemic Associated with Changes in Central Line Dressing Care Accompanying Changes in Nursing Education, Nursing Documentation, and Dressing Supply Kits

BackgroundNational Healthcare Safety Network (NHSN) data have revealed an increase in CLABSI associated with the COVID-19 pandemic, but data on factors mediating the increase are limited. Our hospital had been free of CLABSI for 18 months, but we encountered an outbreak of 7 CLABSI over a 5-month period beginning in November 2020. This led to an investigation that revealed that some underlying issues were related to COVID-19.MethodsInfection prevention staff at Omaha’s Veterans Affairs Medical Center interviewed hospital staff and performed a retrospective chart review of patients with CLABSI (based on the NHSN definition) amid the COVID-19 pandemic.ResultsThe first case of CLABSI in the outbreak was detected in November 2020. Prior to that, there was no case of CLABSI since April 2019, as shown in the graph. Each case of CLABSI was associated with a different microorganism. Further investigation revealed deviations from our usual practices in central line dressing care. Our response to COVID-19 had included alterations in periodic competency training (including dressing care) for nursing staff as well as the rapid introduction of streamlined inpatient nursing documentation. Previously, dressing kits included chlorhexidine-impregnated dressings; in November, a kit without these dressings was introduced. A weekly audit of dressing care was begun in March 2021. No CLABSI was identified in April 2021.Types of Microorganisms identified Different types of microorganisms isolated during the CLABSI outbreak each month. The trend of CLABSI in VA Nebraska-Western Iowa Health Care SystemConclusionWe encountered a CLABSI outbreak associated with deviations from usual central line dressing care. Using the concept of the Swiss cheese model of error prevention, we recognized alterations in three barriers: competency training; thorough documentation; and complete supply kits. The first two of these factors were directly related to our COVID-19 response. Our findings illustrate the relevance of the Swiss cheese model for maintaining a safe healthcare environment.Disclosures Marvin J. Bittner, MD, Merck (Advisor or Review Panel member)Sanofi Pasteur (Speaker's Bureau)

1040 Evaluation of The Use of Biopatch In Haemodialysis Lines: Are We Reducing the Risk of Infection?

Abstract Aim Children who had the central venous lines inserted for prolonged vascular access usually experience the catheter-related blood stream infection (CRBSI). CRBSI is known to be associated with high morbidity which increases the cost of the healthcare and the chances of mortality. Clinical evidence suggests that the use of biopatch (chlorhexidine-impregnated dressing) is effective in reducing the rate of infection in central venous lines. The aim of our study was to evaluate whether the use of biopatch actually reduced the CRBSI in children who had had haemodialysis lines at our institution. Method Theatre logs and electronic records of 46 patients who had haemodialysis lines inserted between 2015-2019 were retrospectively reviewed. These patients were randomly selected. Results The total number of lines inserted in 46 patients were 104. The mean of line per patient was 2.2. Out of 104 lines, 22 lines (21%) had confirmed infection. Conclusions Infection of the central line is still a significant problem. Infections were more prevalent in cases which did not use biopatch according to the documentation. We believe the rate of infection can be reduced by encouraging the use of biopatch on regular basis for the haemodialysis lines and the proper documentation of its use in the operation notes.

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

BackgroundChlorhexidine-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.MethodsAdult 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.ResultsA 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).ConclusionsWe 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 registrationThese studies were registered within ClinicalTrials.gov (numbers NCT01189682 and NCT00417235).

Efficacy of chlorhexidine patches on central line-associated bloodstream infections in children.

Central line-associated bloodstream infections (CLABSIs) are important hospital-acquired infections. Chlorhexidine-impregnated dressings (also known as chlorhexidine patches, CHG patches) are reported to decrease CLABSIs in adults. This study aims to determine the efficacy of CHG patches in reducing CLABSIs in children. An open-label randomized controlled trial was conducted in children aged 2months to 18years, requiring a short-term catheter. Patients were randomized into two groups, allocated to receive CHG patches or standard transparent dressings. Care of the catheter was in accordance with Asia Pacific Society of Infection Control (APSIC) recommendations. Central-line-associated bloodstream infections were defined using National Healthcare Safety Network surveillance criteria. From April 2017 to April 2018, 192 children were enrolled. There were 108 CHG patch catheters and 101 standard dressing catheters, contributing to 3,113 catheter days. The median duration of catheter dwelling was 13days, with an interquartile range (IQR) of 8-20days. Half were placed at the jugular vein and 22% at the femoral vein. There were 23 CLABSI events. Incidence rates for CHG patches and standard dressings were 7.98 (95% confidence interval (CI), 4.25-13.65) and 6.74 (95% CI, 3.23-12.39) per 1,000 catheter days, respectively (incidence rate ratio 1.18; 95% CI, 0.52-2.70). The CLABSI pathogens were 15 Gram-negative bacteria, six Gram-positive bacteria, and two Candida organisms. Catheter colonization of CHG patches and standard dressings were 2.02 (95% CI, 0.42-5.91) and 3.07 (95% CI, 1.00-7.16) per 1,000 catheter days, respectively. Only local adverse effects occurred in 6.8% of the participants. In our setting, there was no difference in CLABSI rates when the chlorhexidine patch dressings were compared with the standard transparent dressings. Strengthening of CLABSI prevention bundles is mandatory.

Management and Prevention of Central Venous Catheter-Related Infections in the ICU

Central venous catheter-related bloodstream infections (CR-BSI) are a frequent event in the intensive care unit (ICU) setting. In contrast to other nosocomial infections, most risk factors for CR-BSI are linked to the device and can be prevented efficiently. Rates of CR-BSI higher than 1 per 1,000 catheter days are no longer acceptable. A continuous quality improvement program is effective to reduce them. Key elements of prevention of CR-BSI are hand hygiene, avoidance of insertion of unnecessary catheters, full sterile barrier precautions at insertion, preferential use of subclavian venous insertion site, cutaneous antisepsis with 2% chlorhexidine alcoholic preparation, use of chlorhexidine-impregnated dressings, immediate replacement of moistened or detached catheter dressings, and removal of catheters as soon as possible. Audit and feedback of the process of care, infection rates, and periodic re-education of health care providers are other instrumental tools in the prevention of CR-BSI. Catheter removal is the main therapeutic intervention, especially recommended in the case of sepsis or shock. While awaiting culture results, an empiric antimicrobial treatment of CR-BSI should target gram-positive microorganism (i.e., Staphylococcus aureus) and gram-negative coverage should be based on clinical variables, patients' risk factors, and previous colonization status. While a short course of antimicrobials (7 days) is sufficient for noncomplicated CR-BSI, a longer course of 14 days should be preferred for uncomplicated S. aureus and Candida CR-BSI. In case of persisting fever or positive blood culture after 3 days despite adequate antimicrobial therapy and catheter removal, catheter-related complications (e.g., endocarditis, thrombophlebitis, septic metastasis) should be ruled out.

Randomized Controlled Trial to Reduce Bacterial Colonization of Surgical Drains with the Use of Chlorhexidine-Coated Dressings After Breast Cancer Surgery.

Breast surgery is considered a clean surgery. However, surgical-site infection (SSI) rates are currently higher than predicted. Postoperative drains remain in situ for several days, with inevitable bacterial colonization and increased SSI risk. This randomized controlled trial from October 2016 to January 2018 analyzed patients undergoing breast cancer surgery. The patients were randomized to either the standard drain care group or the antiseptic dressing group (3M® Tegaderm® CHG). Drain samples taken on postoperative days (PODs) 7 and 14 were cultured as standardized in the laboratory. Colonization rates and SSI were compared between the two groups. The study enrolled 104 patients with 167 surgical drains. The patients' clinical characteristics were similar in the two groups, with no statistically significant differences. Bulb fluid cultures at postoperative week (POW) 1 were positive for 42.9% of the control group and 28.9% of the antiseptic group (p = 0.06). Cultures from the POW 2 assessment were positive for 79.7% of the control group versus 54.9% of the antiseptic group (p = 0.001). Cultures from drain tubes were positive for 79.8% of the control group and 50.7% of the antiseptic group (p = < 0.001). In 11 patients, an SSI developed, 3 (5.8%) from the intervention and 8 (15.4%) from the control procedure (p = 0.11). The study findings demonstrated that the use of antiseptics at the drain exit site significantly reduced bacterial colonization of the closed drainage system in breast cancer surgery. Semi-permeable occlusive chlorhexidine-impregnated dressings provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization and SSI after breast surgery.

Use of Silver-Containing Hydrofiber and Chlorhexidine-Impregnated Tulle Gras Dressings for Second-Degree Burns.

This study evaluated the use of silver-containing hydrofiber and chlorhexidine-impregnated tulle gras dressings for second-degree burns. This randomized clinical study consisted of 60 patients with second-degree burns. Data were collected using a Patient Identification Form, Wound Assessment Form, and Pain Assessment Scale. Following dressing application, wounds were assessed on days 7, 15, and 22. Study procedures were continued until full epithelialization occurred. After the seventh day of follow-up, significant improvement was noted in the experimental group in terms of wound exudate, wound debridement, pain intensity, and analgesic agent administration. After the 15th day of follow-up, there was a significant decrease in epithelialization time in the experimental group. Exudate control was better in patients whose burns were treated with silver-containing hydrofiber dressings, and they needed less debridement and fewer analgesics because of infrequent dressing changes. Lower pain scores were reported, the burn area reduced more quickly, and faster epithelialization and wound healing were achieved. The authors conclude that silver-containing hydrofiber dressings are an effective wound care material that improve the wound healing process. More studies comparing it and other wound care materials could improve the quality of healthcare for patients with burns.

Chlorhexidine-impregnated dressing for the prophylaxis of central venous catheter-related complications: a systematic review and meta-analysis

BackgroundSeveral randomized controlled trials (RCTs) evaluated the role of Chlorhexidine-impregnated dressing for prophylaxis of central venous catheter (CVC) related complications, but the results remained inconsistent, updated meta-analyses on this issue are warranted.MethodsA meta-analysis on the RCTs comparing Chlorhexidine-impregnated dressing versus other dressing or no dressing for prophylaxis of central venous catheter-related complications was performed. A comprehensive search of major databases was undertaken up to 30 Dec 2018 to identify related studies. Pooled odd ratio (OR) and mean differences (MDs) with 95% confidence intervals (CI) were calculated using either a fixed-effects or random-effects model. Subgroup analysis was performed to identify the source of heterogeneity, and funnel plot and Egger test was used to identify the publication bias.ResultsA total of 12 RCTs with 6028 patients were included. The Chlorhexidine-impregnated dressings provided significant benefits in reducing the risk of catheter colonization (OR = 0.46, 95% CI: 0.36 to 0.58), decreasing the incidence of catheter-related bloodstream infection (CRBSI) (OR = 0.60, 95% CI: 0.42 to 0.85). Subgroup analysis indicated that the Chlorhexidine-impregnated dressings were conducive to reduce the risk of catheter colonization and CRBSI within the included RCTs with sample size more than 200, but the differences weren’t observed for those with sample less than 200. No publication bias was observed in the Egger test for the risk of CRBSI.ConclusionsChlorhexidine-impregnated dressing is beneficial to prevent CVC-related complications. Future studies are warranted to assess the role and cost-effectiveness of Chlorhexidine-impregnated dressings.

Innovations in Quality Improvement of Intravascular Catheter-Related Bloodstream Infections

Significant reductions in catheter-related bloodstream infections (CRBSI) have occurred in the United States. Reductions in CRBSIs are attributed to the widespread implementation of the practice-based measures and innovations in the diagnosis, treatment, and prevention of CRBSI. Diagnosis of CRBSI historically required removal of the central venous catheter (CVC) for catheter tip culture. Removing the CVC for CRBSI diagnosis predisposes many patients to potential life-threatening complications. Advances in diagnostic techniques such as culturing catheter hubs, catheter entry site cultures, applying differential time to positivity, molecular diagnostics, biomarkers, and innovative approaches like biosensors on the CVC lumen may provide an alternative to CVC removal. Removal of the CVC is common for the treatment of CRBSI; however, antimicrobial lock therapy is increasingly used as a CVC salvage method. Implementation of newer technology such as antimicrobial coated catheters, chlorhexidine-impregnated dressings, and antiseptic port protectors are crucial for the prevention of CRBSIs. Increasing evidence also support newer sutureless CVC securement devices prevent CRBSIs. CRBSI remains a significant clinical problem despite advances made in the diagnosis, management, and prevention. Molecular techniques are increasingly being used for pathogen identification in CRBSI, but the optimal diagnostic test remains debatable. Increasing experience is being gained with antimicrobial lock therapy for CRBSI treatment with catheter salvage. Use and adherence to practice-based measures and technological innovations has significantly reduced CRBSIs. Continued efforts are required to develop a cost-effective and targeted approach for CRBSI prevention.

Variation in infection prevention practices for peripherally inserted central venous catheters: A survey of neonatal units in England and Wales.

BackgroundThere is uncertainty about the variation in infection prevention practices for central venous catheters (CVC) in neonatal units (NNUs) and how practices relate to national guidance.AimTo evaluate evidence supporting infection prevention practices for CVCs recommended in national guidelines and to compare with reported practices for peripherally inserted central catheters (PICC), a type of CVC widely used in NNUs.DesignWe searched national guidelines for neonates and children to identify infection prevention practices for CVCs and conducted an overview of studies to determine the quality of evidence underpinning recommendations. We surveyed 134 NNUs in England and Wales to ascertain reported practice.ResultsWe found low quality evidence supporting CVC care bundles and use of 2% alcoholic chlorhexidine to decontaminate catheter ports and skin before insertion. Moderate quality evidence supported recommendations against routinely replacing CVCs and against chlorhexidine-impregnated dressings. 90% (44/49) of NICUs and 40% (34/85) of LNUs responded. 66% (48/73) of NNUs reported using CVC care bundles for insertion; 62% (45/73) used bundles for maintenance. 63% (32/51) of those using bundles reported monitoring adherence. 85% (61/72) of NNUs did not routinely replace PICCs and 89% (63/71) did not use chlorhexidine-impregnated dressings. Antiseptic use varied with alcoholic 2% chlorhexidine used for skin preparation in 33% (23/71) of NNUs and for catheter ports in 52% (37/71).ConclusionsLack of consistency across NNUs in antiseptic use and low rates of reported CVC care bundle use may reflect the low quality of evidence of the effectiveness and safety of these interventions in NNUs. Clinical trials are needed to quantify benefits and harms of infection prevention practices in NNUs.

Cost effectiveness of dressing in the prevention of catheter-related infection in critically ill patients

Catheter-related infection is a complication of high morbimortality. The aim was to perform a cost-effectiveness analysis of gauze and medical tape, transparent semi-permeable and chlorhexidine-impregnated dressings for short-term central venous catheter, within the Brazilian Public Healthcare System (Sistema Único de Saúde - SUS) scenario. a decision tree was elaborated in order to evaluate the cost-effectiveness of dressings in the prevention of catheter-related infection in critically ill patients. The outcome was the probability of catheter-related infections prevention. Moreover, only direct medical expenses were considered. Sensitivity analyses were performed to evaluate the model uncertainties. Chlorhexidine-impregnated dressing presented higher cost-effectiveness when the base case was analyzed (cost of US$ 655 per case prevented, 99% of effectiveness), in comparison to gauze and medical tape dressing (US$ 696, effectiveness of 96%). Dressing changes performed before the recommended period, treatment performed exclusively in inpatient units and high effectiveness of gauze and medical tape dressing were variables that interfered with the results. The probability of death has also demonstrated to have a major impact on cost-effectiveness. In the context of a Brazilian public hospital, the chlorhexidine-impregnated dressing presented higher cost-effectiveness when compared to the gauze and medical tape dressing or the transparent semi-permeable dressing.

Effect of an acrylic terpolymer barrier film beneath transparent catheter dressings on skin integrity, risk of dressing disruption, catheter colonisation and infection

ObjectivesWe assessed the effect of a skin-protective terpolymer barrier film around the catheter insertion site on frequency of dressing disruptions and skin integrity issues (hyperaemia, skin irritation, residues of adhesives and moisture under the dressing). Secondary outcomes included colonisation of the central venous catheter (CVC) and rates of central line-associated bloodstream infection. Research methodologyA monocentric, open-label, randomised controlled trial was performed comparing a control group receiving standard transparent catheter dressings without the skin-protecting barrier film and an intervention group receiving a transparent chlorhexidine-impregnated dressing with use of the skin-protective acrylic terpolymer barrier film (3M™ Cavilon™ No - Sting Barrier Film, 3 M Health Care, St. Paul, MN, USA). ResultsSixty patients were enrolled and randomised in the study accounting for 60 central venous catheters and a total of 533 catheter days. Dressing disruptions occurred more frequently and at sooner time point in the control group. Skin integrity issues were significantly less observed in the intervention group. No differences in CVC colonisation or central line-associated bloodstream infection were observed. ConclusionsThe application of a barrier film creating a skin-protective polymer layer beneath transparent catheter dressings is associated with less dressing disruptions and skin integrity issues without altering the risk of infectious complications if used in combination with a chlorhexidine-impregnated catheter dressing.

Local Cutaneous Effects Associated with Chlorhexidine-Impregnated Gel Dressing in Hematopoietic Stem Cell Transplantation Patients

Introduction: Hematopoietic stem cell transplantation (HSCT) often requires a central venous catheter (CVC) for quick and safe vascular access. Currently, new technologies are available to protect the catheter insertion site, such as chlorhexidine-impregnated gel dressings (CIGD). Objectives: To evaluate local cutaneous effects associated with CIGD in patients undergoing HSCT. Methods: In this cross-sectional, prospective study, we evaluated 25 HSCT patients who had a CVC inserted. Patients were visited daily to monitor the CIGD changing procedures and evaluate abnormalities of the underlying skin after dressing removal. Findings: Local erythema was the most frequently detected abnormality, although usually transient and considered secondary to the mechanical trauma of dressing removal. The most severe lesions, consisting of areas of skin loss, erythematous plaques and/or vesicles were classified as skin irritation and presented in 11 (44%) of the 25 patients. An association test showed that skin irritation was more frequent in patients who underwent allogeneic HSCT (p = 0.03). Skin irritation was most frequently observed in areas of contact with the non-woven polyester adhesive tape (n = 22; 88%), which made up the adhesive margins of the dressing. The CIGD was discontinued in 6 (54%) of the 11 patients who presented severe skin injuries. Conclusion: In this study, we detected that skin irritation was more frequent in patients who underwent allogeneic HSCT. The most common skin manifestation was skin loss.

Frequency of change of chlorhexidine-impregnated gel dressings for central venous catheters in critically ill patients

Abstract Objectives: To identify the frequency of change of chlorhexidine-impregnated gel dressings applied in central venous catheter insertion sites, describe reasons for dressing changes, and identify the amount of dressings used per adult patients admitted to an intensive care unit. Methods: Descriptive study consisting of daily record of occurrence evaluation, reason for dressing change and quantity used per patient, between April and December 2014. Descriptive statistical analysis was used. Results: A total of 159 dressings were applied at the insertion site of 64 central venous catheters whose mean frequency of dressing changes was 3.04 days. The mean number of dressing per patient was 3.1, but 83 unscheduled changes occurred before 7 days of stay, due to detachment, wetness, soiling, and loss of dressing. Conclusion: The frequency of dressing changes was less than seven days, resulting in greater quantities of dressings per patient. Detachment was the most common reason for unscheduled dressing changes.