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To decrease the incidence of intravascular catheter–related bloodstream infections in ICUs, medical centers have adopted such preventive strategies as using checklists, best-practice “bundles,” and antimicrobial-impregnated catheters. Chlorhexidine gluconate–impregnated sponge (CHGIS) dressings have aroused great interest, but data to support this approach are limited.
In a recent multicenter, randomized, controlled, four-arm trial, investigators in France compared CHGIS dressings with standard ones and also compared routine 3-day with 7-day dressing changes. Participants were adult ICU patients between December 2006 and May 2008 who were expected to require an arterial catheter, a central venous catheter, or both for ≥48 hours. Pulmonary arterial, hemodialysis, and peripherally inserted central venous catheters were not included. All catheters in a given patient were managed in the same way; dressings were donated by the manufacturer.
A total of 1636 patients were included. Use of CHGIS dressings lowered the incidence of major catheter-related infection (CRI; i.e., catheter-related sepsis with or without bloodstream infection) from 1.4 to 0.6 per 1000 catheter-days (P=0.03), with no apparent emergence of chlorhexidine-resistant pathogens and only a minimal rate of contact dermatitis (2% in the CHGIS group and 1% in controls). Catheter colonization rates were similar between the 3-day and 7-day dressing-change groups; however, the frequency of dressing changes differed little between groups because of the need for unplanned changes.
Timsit J-F et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: A randomized controlled trial. JAMA 2009 Mar 25; 301:1231.
Comment
Several aspects of this study may have affected the observed incidence of infections. For example, 46% of evaluated catheters were arterial, 36% were in a femoral location, and antimicrobial-impregnated catheters were excluded. In addition, the baseline CRI rate was very low (although it was calculated using a definition that is slightly different than the CDC’s). The observed 57% reduction in CRI incidence in this setting is striking and shows a major advantage to using CHGIS dressings, even in hospitals that have achieved low infection rates with other interventions.