Chlorhexidine Dressings Cut Catheter-Related Infections
The rate of major catheter-related infections among patients in the intensive care unit decreased by 60% when dressings impregnated with chlorhexidine gluconate were secured over insertion sites for arterial or central venous catheters, investigators reported.
That decrease was achieved among ICU patients participating in a multicenter study in France, even though the background rate of catheter-related infections already was extremely low, said Dr. Jean-Francois Timsit of University Joseph Fourier, Grenoble, France, and his associates.
They conducted a randomized, controlled trial to assess chlorhexidine-impregnated sponges because small, unpublished studies of the dressings had yielded promising results.
The trial involved 1,636 medical and surgical patients treated in seven ICUs at three university hospitals and two general hospitals. The patients were randomly assigned to receive either chlorhexidine dressings or standard dressings over catheter insertion sites.
Use of the chlorhexidine dressings cut the rate of major catheter-related infections from 1.4/1,000 catheter-days to 0.6/1,000 catheter-days.
That protective effect was consistent both for gram-negative and gram-positive organisms, as well as for arterial and central venous catheters, the investigators said (JAMA 2009;301:1231–41).
Skin and catheter cultures showed a significant decrease in bacterial colonization with the chlorhexidine dressings.
The researchers estimated that the number needed to treat to prevent one major infection was 117 catheters.
Eight patients who were treated with the chlorhexidine dressings developed contact dermatitis, which resolved when the dressings were removed. All of these eight patients had multiple organ failures, subcutaneous edema, and fragile skin.
Dr. Timsit and his colleagues also studied whether decreasing the number of dressing changes (following the first such change at 24 hours after catheter insertion) would affect infection outcomes.
The group of patients who were assigned to a delayed dressing change every 7 days showed a rate of catheter-related infection similar to the rate of the group assigned to the standard number of dressing changes (every 3 days).
That finding suggests that it is probably safe to delay dressing changes in order to minimize occasions for potential catheter contamination—“provided the dressings are closely monitored and changed immediately should separation or soiling be detected,” the investigators added.
The study results “have the potential to change the standard of care for insertion and maintenance of intravascular catheters,” noted Dr. Eli N. Perencevich of the University of Maryland, Baltimore, and Dr. Didier Pittet of the University of Geneva Hospitals and the World Health Organization Alliance for Patient Safety, in an editorial comment that accompanied the report.
The “relatively simple” use of a chlorhexidine-impregnated dressing may decrease further the already low rates of infection that are achieved through the use of optimal ICU practices, they said in their commentary (JAMA 2009;301:1285–7).
