Prevention Of Catheter-related Infections Research Articles

Recent developments in preventing catheter-related infections based on biofilms: A comprehensive review.

Urinary and vascular catheters are among the most commonly used medical devices. However, infections caused by biofilm formation on the surface of catheters are a major cause of healthcare-associated infections. Traditional methods, such as using antimicrobials to prevent such infections, generally have short-term effects, and treatment is challenging owing to the emergence of antimicrobial-resistant bacteria. This review aims to evaluate the limitations of conventional catheter-related infection prevention efficacy, such as currently used antimicrobials, and analyze the efficacy and limitations of potential alternatives to prevent catheter-related infections that have not yet been commercialized, classified by the transition stages of biofilm formation. We intend to provide profound insights into the ideal technologies for preventing catheter-associated tract infections and present perspectives on future directions in this field.

Lock Therapy for Treatment and Prevention of Catheter-related Infections.

Lock Therapy for Treatment and Prevention of Catheter-related Infections.

A Randomized Controlled Clinical Trial of Trisodium Citrate 30% versus Heparin as a Lock Solution for the Prevention of Catheter-Related Infections in Adult Hemodialysis Patients

Abstract Background Central venous catheters (CVC) are the only option when hemodialysis is needed for patients without definitive vascular access. However, CVC is associated with complications, such as infection, thrombosis, and dysfunction, leading to higher mortality and expenditures. Interdialytic hemodialysis catheter-locking solutions could contribute to reduction of catheter-related complications, especially infections. Aim of the Work To assess the possible effect of using Trisodium citrate 30% (TSC 30%) in comparison to unfractionated heparin, as a lock solution for hemodialysis catheters, on inflammatory status in HD patients Patients and Methods This was a randomized controlled clinical trial, conducted on 70 patients on regular hemodialysis, selected from hemodialysis unit in Nasser Institute Hospital in Cairo government, divided into two groups: (Citrate Group); 35 patients received trisodium citrate, (Heparin Group); 35 patients received unfractionated heparin (5000i.u) as a hemodialysis lock solution after the end of HD session and followed up for 3 months. Result In our study, the catheter-related bacteremia episodes were significantly lower in the Citrate group when compared with those in the Heparin group. Only 2 patients (5.7%) in Citrate group had CRBSI, whereas in Heparin group, 8 patients (22.9%) had CRBSI (P = 0.04). Also, Bacteremia-free time was longer in the Citrate group. The mean bacteremia free time in Citrate group was 10.97 ± 2.36 weeks, while in Heparin group it was 9.43 ± 3.91 weeks (P = 0.032). At base line, there was no significant difference between both groups regarding hsCRP (P = 0.596) and WBCs (P = 0.528). While after 3 months of using TSC 30% as a lock solution, there was a significant difference as regards levels of hsCRP (P = 0.030) and WBCs (P = 0.036), with the higher levels of inflammatory markers showed in Heparin group. There was no difference between the two studied groups regarding thrombosis, however, catheter performance was higher in citrate group after 3 months assessed by URR (P = 0.005) compared to baseline (P = 0.108), Conclusion We found that Trisodium citrate 30% may be a better alternative to heparin as a catheter lock solution as it reduces the inflammatory markers and CRBSI incidence. We therefore believe that TSC 30% may be used safely as catheter lock solution in Hemodialysis

Clinical impact of catheter insertion for peritoneal dialysis on patient survival and catheter-related complications.

The stepwise initiation of peritoneal dialysis (PD) using Moncrief and Popovich's technique (SMAP) for catheter insertion is recommended for the systemic introduction of PD and prevention of catheter-related infections. In this study, we investigated patient outcomes in patients who underwent insertion of a PD catheter with a direct method versus the SMAP method. We enrolled 295 consecutive patients who underwent PD as a primary renal replacement therapy and underwent insertion of a PD catheter at our institute between 2006 and 2021. We retrospectively reviewed their data and investigated patient outcomes, including mortality and PD catheter-related complications. Median age at PD induction was 65years in the direct insertion group and 65years in the SMAP group (P = 0.80). The rate of PD introduction after emergency hemodialysis was significantly higher in the direct insertion group than in the SMAP group (P < 0.001). There was no significant difference in survival between the direct insertion and SMAP groups during the median follow-up period of 54months (P = 0.12). Additionally, patients who transitioned to hemodialysis or kidney transplantation after PD showed significantly longer survival (P < 0.001). The incidence of PD catheter-related complications was not significantly different between the two groups. A body mass index ≥ 23kg/m2 was an independent risk factor for peritonitis and exit-site infection (P = 0.006 and P = 0.011, respectively). Planned sequential renal replacement therapy including hybrid hemodialysis, complete hemodialysis, and kidney transplantation after PD is important for improving patient outcomes. PD catheter insertion by SMAP may not be mandatory in our clinical practice.

Evidence-based Clinical Practice Guidelines for the Prevention of Catheter-Related Infections among Patients Undergoing Haemodialysis

Evidence-based Clinical Practice Guidelines for the Prevention of Catheter-Related Infections among Patients Undergoing Haemodialysis

The effect of single dose prophylactic vancomycin before semi-permanent catheterization to prevent catheter related infection; a randomized controlled trial, phase II

Introduction: Catheter-related infections are a common complication and a major cause of morbidity and mortality in hemodialysis patients with tunneled central venous catheters. The optimal strategy for the management and prevention of catheter-related infections is unclear. Objectives: This study is aimed to evaluate the single-dose prophylactic vancomycin efficacy before semi-permanent catheterization to prevent catheter-related infection. Patients and Methods: This randomized double-blind controlled clinical trial was conducted on patients with chronic renal failure requiring hemodialysis and insertion of a double-lumen central venous catheter admitted to Ahvaz Golestan Hospital. The intervention group (n=30) received 1 g of vancomycin intravenously one hour before catheter insertion and the control group (n=30) received an equal amount of normal saline. The incidence of catheter-related infections and other complications for 6 months was evaluated. Results: During the 6-month follow-up, hospitalization due to catheter-related infection and the need for antibiotic administration was observed in 9 patients (30.0%) who received vancomycin and 14 patients (46.7%) in the control group (P=0.184). Catheter extraction due to infection was observed in 4 patients of the vancomycin group (13.3%) and 6 patients of the control group (20.7%) (P=0.451). Complications other than infection were observed in four patients (13.3%) in each group (P=1.000). The mean time to onset of infection was 2.43 ±0.38 months in the control group and 3.85 ± 0.42 months in the vancomycin group (P=0.002). Conclusion: Although a single dose of intravenous vancomycin one hour before insertion of a bi-luminal hemodialysis catheter did not show a significant effect on preventing catheter-related infections over 6 months, it significantly delayed the onset of infection. Trial Registration: The trial protocol was approved by Iranian Registry of Clinical Trial (Ethical code: IR.AJUMS.HGOLESTAN.REC.1399.106 and IRCT code: IRCT20201206049617N1; https://www.irct.ir/trial/52832).

Nitric Oxide-Releasing Lock Solution for the Prevention of Catheter-Related Infection and Thrombosis.

Although frequently used, venous catheters are often associated with serious complications such as infection and thrombosis. Lock solution therapies are clinically used to deter these issues but generally address only infection or thrombosis with limited success. Here, we report the development of a dual-functional lock therapy using nitric oxide (NO) donor molecule, S-nitrosoglutathione (GSNO). NO is a potent, broad-spectrum antimicrobial agent that also temporarily inhibits platelet activation, preventing thrombosis. Furthermore, NO has antibiofilm actions, an ability that traditional antibiotic lock solutions lack, thus limiting their efficacy. In this work, different concentrations of GSNO were characterized via NO analysis to determine a range of NO-releasing lock solution (NOreLS) concentrations to investigate and to demonstrate prolonged potential efficacy. Tested against clinically used vancomycin and gentamicin lock solutions, GSNO-based NOreLS repeatedly outperformed in models of different stages of catheter infections. NOreLS also prevented clot formation when exposed to whole blood, showing increased efficacy compared to a heparin lock solution. Moreover, NOreLS was demonstrated to be biocompatible via hemolysis and cytotoxicity assays. NOreLS has excellent potential for safely and effectively preventing infection and thrombosis related to catheter usage.

Профілактика інфекцій при тяжких ушкодженнях мозку: акцентування на вентилятор-асоційовану пневмонію і зовнішнє вентрикулярне дренування

Вентилятор-асоційована пневмонія у пацієнтів із тяжкою черепно-мозковою травмою може досягати 40 %, і це значною мірою пов’язано з тривалим впливом механічної вентиляції легень. Наявність вентилятор-асоційованої пневмонії посилює тяжкість захворювання, що асоційоване з такими факторами, як гіпоксія, лихоманка, гіпотензія, збільшення внутрішньочерепного тиску. Пацієнти з інвазивним моніторингом інтракраніального тиску мають високий інфекційний ризик, що становить 27 %. У статті, виходячи з позицій Guidelines for Management of Severe Traumatic Brain Injury 4th Edition 2016, наведено дані щодо попередження ризиків розвитку інфекцій, пов’язаних із вентилятор-асоційованою пневмонією (рання — пізня трахеостомії, обробка ротової порожнини повідон-йодом) і зовнішнім вентрикулярним дренуванням (застосування катетерів, імпрегнованих антибіотиками).

Negative-pressure wound therapy is effective for peritoneal dialysis catheter exit-site management in the early postoperative period

Peritoneal dialysis (PD) catheter exit-site care is critically important for the prevention of catheter-related infections (CRIs) and subsequent peritonitis. The postoperative management of the site is particularly essential because it has an open wound that is always adjacent to a PD catheter tube. This study aimed to examine the effectiveness of negative-pressure wound therapy (NPWT) for postoperative PD catheter exit sites. Thirty patients with end-stage renal disease who underwent simultaneous PD catheter insertion and exit-site formation were randomly assigned to receive NPWT (NPWT group) or conventional dressing (non-NPWT group) for the first seven postoperative days. The exit-site scores on the seventh postoperative day was lower in the NPWT group than in the non-NPWT group (p = 0.0049). Analysis of variance F statistic for the effect of NPWT over 180 days was highly significant (11.482595, p = 0.007). There were no statistically significant differences between the time to first CRI and PD-related peritonitis between the two groups. There was one case of CRI with relapsing peritonitis and catheter loss in the non-NPWT group. These findings demonstrate the association between NPWT and low exit-site score. NPWT can be recommended for the management of PD catheter exit sites in the early postoperative period.

Antimicrobial activity of hemodialysis catheter lock solutions in relation to other compounds with antiseptic properties.

Proper protection of vascular access after haemodialysis is one of the key measures for the prevention of catheter-related infections. Various substances with bactericidal and anticoagulant properties are used to fill catheters, but due to the unsatisfactory clinical effects and occurrence of adverse reactions, the search for new substances is still ongoing. In the present paper, we compared the in vitro antimicrobial activity of solutions used for tunnelled catheter locking (taurolidine, trisodium citrate) and solutions of substances that could potentially be used for this purpose (sodium bicarbonate, polyhexanide-betaine). The studies have been conducted on bacteria that most commonly cause catheter-related infections. The values of both minimum inhibitory concentration and minimum biofilm eradication concentration of the substances were determined. The ability of the tested substances to eradicate biofilm from the dialysis catheter surface was also evaluated. The results showed that polyhexanide-betaine inhibited the growth of all microbes comparably to taurolidine, even after ≥ 32-fold dilution. The activity of trisodium citrate and sodium bicarbonate was significantly lower. Polyhexanide exhibited the highest activity in the eradication of bacterial biofilm on polystyrene plates. The biofilm formed on a polyurethane dialysis catheter was resistant to complete eradication by the test substances. Polyhexanide-betaine and taurolidine showed the highest activity. Inhibition of bacterial growth regardless of species was observed not only at the highest concentration of these compounds but also after dilution 32–128x (taurolidine) and 32–1024x (polyhexanide-betaine). Therefore, it can be assumed that taurolidine application as a locking solution prevents catheter colonization and systemic infection development. Taurolidine displays high antimicrobial efficacy against Gram-positive cocci as well as Gram-negative bacilli. On the contrary, the lowest antibacterial effect displayed product contained sodium bicarbonate. The inhibitions of bacterial growth were not satisfactory to consider it as a substance for colonization prevention. Polyhexanidine-betaine possessed potent inhibitory and biofilm eradication properties comparing to all tested products. PHMB is applied as a wound irrigation solution worldwide. However, based on our results, we assume that the PHMB is a promising substance for catheter locking solutions thanks to its safety and high antimicrobial properties.

Preclinical evaluation of passive disinfection caps with a long-term catheter for the prevention of catheter-related bloodstream infection in pediatric cancer patients.

The use of passive disinfection devices (disinfection caps) may be a beneficial part of a maintenance care bundle, aiming at the prevention of catheter-related bloodstream infections in pediatric cancer patients. This preclinical in vitro investigation tested the visual and mechanical integrity of a Broviac™ catheter hub after simulation testing with 122 3M™ CurosTM Stopper Disinfection Caps for Open Female Luers repeatedly attached and removed over 6 months. We found that these catheter hubs were compatible, fully operational, and airtight with use of 3M Curos stopper caps after 6 months of use with 122 caps per catheter hub.

Eradication of Staphylococcus aureus colonization by chronic use of mupirocin in patients on home parenteral nutrition.

Although in other groups Staphylococcus aureus eradication has proven to be an effective infection prevention measure, to our knowledge, no such studies have been performed in patients on home parenteral nutrition (HPN). The aim of this study was to investigate the efficacy of chronic nasal mupirocin use on S. aureus eradication and prevention of catheter related infections in patients on HPN. This was a cohort study with data collected from adult patients on HPN who were screened for S. aureus carriage. In case of carriage, the patient was instructed to apply mupirocin nasal ointment monthly. Outcomes were the percentage of successful S. aureus eradication and the effect on the incidence of catheter-related infections and development of mupirocin resistance. S. aureus nasal carriage was found in 54% of the patients. Eradication was successful in 66% (70 of 106) of patients treated with mupirocin. Overall S. aureus catheter-related infection rates decreased by 50% (P=0.02). The decrease was mostly due to a drop in central line-associated bloodstream infection (CLABSI) rates (0.26versus 0.1 per 1000 central venous catheter days; P=0.04). The overall CLABSI rates decreased as well (incidence ratio rate, 0.43; 95% confidence interval. 0.24-0.76; P < 0.01). Low-level mupirocin resistance was observed in four patients. Findings from the present study highlighted the potential usefulness of mupirocin ointment prophylaxis to establish S. aureus eradication in patients on HPN. However, awareness for the development of mupirocin resistance is prudent. Further research needs to be carried out to validate these findings.

Retrospective Analysis of Microbial Colonization Patterns in Central Venous Catheters, 2013-2017.

Objectives This study was performed to provide epidemiological information on microbial colonization in central venous catheters (CVCs). Methods CVCs submitted to Medical Microbiology Laboratory from January 1, 2013, through October 1, 2017, which met our criteria would be included for analysis. Quantitative culture was used for CVCs. The results of culture and related information on CVCs were collected and recorded in detail. The prevalence was calculated, and related factors were analyzed statistically. Results A total of 2020 CVCs were submitted for culture and eligible for analysis. Positive microbial culture occurred in 379 catheters with 18.7% (379 of 2020) prevalence of colonization. There were 23 microbial genera and 45 organisms detected. Among the isolated organisms, there were 39 kinds of isolated bacteria and 6 kinds of isolated fungi. Acinetobacter (19.8%) predominated in total isolated microorganisms, followed by Staphylococcus epidermidis (11.3%) and Candida albicans (10.3%). There were no significant differences in isolated organisms and fungal species between different sexes (X2 = 2.365, P = 0.50). Conversely, there were significant differences in isolated bacterial and fungal species between different wards and years (X2 = 124.046, P = 0.000; X2 = 77.064, P = 0.000). A total of 107 (5.3%, 107/2020) CVCs were associated with a diagnosis of central line-associated bloodstream infection (CLABSI). The most common organisms in causing CLABSI were Acinetobacter (23.4%), S. aureus (13.1%), and Candida albicans (12.1%). Conclusion The prevalence of microbial colonization in CVCs is still significant and even has gradually changed over time. The study provides a new view of microbial colonization pattern in CVCs and a prevalence of CLABSI, which will facilitate catheter-related infection prevention and control in clinic.

Ethanol locks for the prevention of catheter-related infection in patients with central venous catheter: A systematic review and meta-analysis of randomized controlled trials.

BackgroundThe widespread use of central venous catheters (CVCs) has exposed patients to a high risk of catheter-related infection (CRI), which is linked to substantial morbidity and mortality. Several strategies for preventing CRI, including ethanol lock prophylaxis, have been explored. This study aimed to provide a comprehensive summary of randomized controlled trials (RCTs) assessing the efficacy and safety of ethanol locks for preventing CRI in patients with CVC.MethodsWe searched six electronic databases, earlier relevant meta-analyses and the reference lists of the included studies for RCTs that assessed the effects of ethanol locks on CRI in patients with CVC versus a control group. Two authors independently assessed the methodological quality of the included studies using the Cochrane Risk of Bias tool and extracted relevant information according to a predesigned extraction form. Data were analyzed using the Cochrane Collaboration’s RevMan 5.3.ResultsNine studies involving 2451 patients were included. Although limited in power, the results of the meta-analysis indicated a positive effect of ethanol lock prophylaxis on reducing catheter-related bloodstream infection (CRBSI) compared to heparin alone [OR = 0.53, 95% CI 0.34, 0.82, P = 0.004]. The effects on other outcomes, such as exit site infection, catheter dysfunction, catheter removal, thrombosis and mortality, were not statistically significant (P > 0.05). Moreover, although the effect of ethanol on CRBSI was in the expected direction compared to 0.9% NaCl locks, this effect was not statistically significant (P > 0.05).ConclusionsThe present data indicate that ethanol lock prophylaxis is a potential candidate for the prevention of CRBSI in patients with CVC. However, more attention should be paid to the uniform ethanol lock procedure and toxic effects after long-term ethanol lock exposure.

Dressings for the central venous catheter to prevent infection in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis

To identify the most effective dressing for covering long-term central venous catheter exit site to prevent catheter-related infections and skin irritation in patients undergoing hematopoietic stem cell transplantation. Systematic Review. The search was performed in the following electronic databases: CINAHL, Cochrane Library CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science. Google Scholar was used for the gray literature search. Seven studies were included which tested different arrangements of dressings: sterilized gauze and adhesive tape with a transparent polyurethane film (n = 2), transparent polyurethane film with a different replacement interval frequency (n = 2), transparent polyurethane film with and without chlorhexidine released continuously by the dressing at the site of intravascular catheter insertion (n = 2), and dressings vs. no dressings (n = 1). The meta-analysis for catheter-related infection prevention showed no difference between type of dressing (RR 1.76, [95% CI 0.82; 3.75], I2 0%) and for the replacement frequency at different intervals (RR 1.04, [95% CI 0.67; 1.61], I2 0%). The meta-analysis for skin irritation evaluated the transparent polyurethane film replacement frequency and indicated that a longer dressing replacement interval (10 to 15days) reduces the risk of developing this outcome (RR 0.71, 0.52; 0.96, 95% CI, I2 24%). Regarding the type of the dressing, there is no evidence indicating the best dressing. Although there is no evidence available for the ideal replacement frequency, the risk to develop skin irritation is reduced in longer dressing replacements intervals.

Control of Gram-negative multi-drug resistant microorganisms in an Italian ICU: Rapid decline as a result of a multifaceted intervention, including conservative use of antibiotics

BackgroundGram-negative Multi-Drug-Resistant Organisms (GNMDROs) cause an increasing burden of disease in Intensive Care Units (ICUs). We deployed a multifaceted intervention to control selection and transmission of GNMDROs and to estimate at which rate GNMDROs would decline with our interventional bundle. MethodsInterventions implemented in 2015: in-ward Antimicrobial-Stewardship-Program for appropriate management of antimicrobial prescription; infection monitoring with nasal/rectal swabs and repeated procalcitonin assays; 24 h microbiological support (since 2016); prevention of catheter-related infections, VAPs and in-ward GNMDROs transmission; education of ICU personnel. In May 2017, epidemiological, clinical and microbiological data were collected and retrospectively analyzed. Rates of resistance in Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, as well as percentages of resistance among all Gram-negative bacteria were compared during the study period. ResultsOf 668 patients, at least one isolate was obtained from 399 patients. The proportions of patients with infection and with Gram-negative isolates were even across the 5 semesters (p = 0.8). For Klebsiella pneumoniae, the number of strains resistant to carbapenems fell from 94% to 6% (p < 0.001). Significant drops were also observed for Pseudomonas aeruginosa and Acinetobacter baumannii. Percentages of resistance for all Gram-negative isolates fell from 91% to 13% (p < 0.0001). The reduction in antibiotic prescription translated in a considerable reduction of pharmacy costs. Multivariate models confirmed that the hospitalization semester was the most relevant independent predictor of resistance among Gram-negative bacteria. ConclusionsOur experience provides further evidence that a multi-faceted intervention, aimed to reduce selection and transmission of GNMDROs with efficient microbiological support, may yield remarkable results in a short time interval.

Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients: A pilot randomised controlled trial

BackgroundIn patients with short-term percutaneous central venous catheter (CVC), it is recommended that a dressing be applied to the catheter insertion site to prevent catheter-related infections. ObjectivesThe objective of this study was to assess the feasibility of a randomised controlled trial to compare the efficacy of chlorhexidine-impregnated dressing with that of polyurethane dressing in the prevention of catheter-related infections in critically ill adult patients with short-term percutaneous CVC. MethodsOne hundred fifteen patients with a CVC were randomised to chlorhexidine-impregnated gel dressing (chlorhexidine gel group) or transparent polyurethane dressing (polyurethane group) between April and December 2014. Feasibility outcomes included data on eligibility, recruitment, missing data, and protocol violation. The primary outcome measure of efficacy was the presence of colonisation with the same microorganism in both the skin swab around catheter insertion site and the catheter tip. ResultsOf 526 patients assessed for eligibility, 411 (78%) did not meet inclusion criteria, and 115 (22%) were randomised. Among participants of both groups, there were 14 missing primary outcomes of which 10 were due to failure to collect the catheter tip (a protocol violation). The final sample had 47 and 54 individuals in the chlorhexidine and polyurethane groups, respectively. Skin and catheter tip were colonised by the same microorganism for 13% of the participants in the chlorhexidine group and 8% in the polyurethane group, although the difference was not statistically significant (p = 0.51). There were no differences between the two groups for catheter tip colonisation, skin site colonisation, catheter insertion site infection, catheter-related bloodstream infection, skin irritation, and the number of unplanned dressing changes. ConclusionsOur preliminary results found that a large randomised controlled trial would be feasible. This study provides valuable information that can be used to design more robust studies to prevent infection among patients with short-term percutaneous CVC when using either chlorhexidine or polyurethane dressing.

A randomized controlled clinical trial of 4% sodium citrate versus heparin as locking solution for temporary dialysis catheters among hemodialysis patients .

Limited reports are available on the role of 4% citrate as a locking solution for temporary dialysis catheters. Hence, the aim of this study is to investigate the role of 4% citrate vs. heparin 5,000 µ/mL as a catheter-locking solution in a randomized controlled trial. The trial was conducted in Egypt where the use of non-tunneled temporary catheters is prevalent compared to tunneled long-term catheters. The efficacy of catheter-locking solutions was compared regarding observation of rate of catheter dysfunction, low-flow pump, fever as a sign of central-line blood-stream infection (CLBSI), catheter-site infection, thrombosis, local bleeding, and systemic bleeding in each group of the study. Each group consisted of 105 patients. The number of patients who developed CLBSI in the citrate group was 11 (10.5%) compared to 23 (21.9%) in the heparin group (p < 0.025). The number of patients who developed catheter dysfunction in the citrate group was similar to those in the heparin group. The incidence of catheter-site infection, thrombosis, and local bleeding in the citrate group was similar to that in the heparin group. Citrate 4% lock solution is equally effective as heparin in maintaining catheter patency in dialysis patients. It may have a favorable effect on prevention of catheter-related infection due to its additional antiseptic properties as compared to heparin. Citrate-based locking solutions are a promising alternative to unfractionated heparin as a locking solution for dialysis catheters. .

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.

How do antimicrobial dressings compare with standard dressing for prevention of catheter-related infection in newborn infants with central venous catheters?

How do antimicrobial dressings compare with standard dressing for prevention of catheter-related infection in newborn infants with central venous catheters?