Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study.
BACKGROUND
Infections of short term, nontunneled, intravascular catheters are often caused by migration of organisms from the insertion site. The aim of this study was to evaluate the effectiveness and safety of a chlorhexidine gluconate-impregnated dressing for the reduction of central venous catheter (CVC) colonization and CVC-associated bloodstream infections in infants and children after cardiac surgery.


METHODS
This prospective, randomized, controlled study was conducted in the pediatric cardiac intensive care unit of a tertiary care pediatric medical center. Patients 0-18 years of age who were admitted to the pediatric cardiac intensive care unit during a 14-month period and required a CVC for >48 hours were randomized to receive a transparent polyurethane insertion site dressing (control group) or a chlorhexidine gluconate-impregnated sponge (Biopatch) dressing covered by a transparent polyurethane dressing (study group). The main outcome measures were rates of bacterial colonization, rates of CVC-associated bloodstream infections and adverse events.


RESULTS
Seventy-one patients were randomized to the control group and 74 to the study group. There were no significant between group differences in age, sex, Pediatric Risk of Mortality score or cardiac severity score. CVC colonization occurred in 21 control patients (29%) and 11 (14.8%) study patients (P = 0.0446; relative risk, 0.6166; 95% confidence interval, 0.3716-1.023). Bloodstream infection occurred in 3 patients (4.2%) in the control group and 4 patients (5.4%) in the study group. Local redness was noted in 1 control patient and 4 study group patients.


CONCLUSIONS
The chlorhexidine gluconate-impregnated sponge is safe and significantly reduces the rates of CVC colonization in infants and children after cardiac surgery.
Levy
Itzhak
I
Department of Pediatric Infectious Diseases, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. lavyguy@bezeqint.net
Katz
Jacob
J
Solter
Ester
E
Samra
Zmira
Z
Vidne
Bernardo
B
Birk
Einat
E
Ashkenazi
Shai
S
Dagan
Ovadia
O
D000279:Administration, Cutaneous; D000293:Adolescent; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001458:Bandages; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies
D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine