title: Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis.
abstract: OBJECTIVE
  Vascular and epidural catheter-related infections cause significant morbidities and mortality in hospitalized patients. This meta-analysis assessed the effect of chlorhexidine-impregnated dressing on the risk of vascular and epidural catheter bacterial colonization and infection.
  
  
  METHODS
  Literature search was based on MEDLINE (1966 to 1 November 2005), EMBASE and Cochrane Controlled Trials Register (2005 issue 3) databases. Only randomized controlled clinical trials comparing chlorhexidine-impregnated dressing with placebo or povidine-iodine dressing were included in this meta-analysis. Two reviewers reviewed and extracted the data independently.
  
  
  RESULTS
  Eight studies assessing a single type of chlorhexidine-impregnated dressing were identified and subjected to meta-analysis. The chlorhexidine-impregnated dressing reduced the risk of epidural [3.6% versus 35%, odds ratio (OR) 0.07, 95% CI: 0.02-0.31, P=0.0005] and intravascular catheter or exit-site bacterial colonization (14.8% versus 26.9%, OR 0.47, 95% CI: 0.34-0.65, P<0.00001) (overall 14.3% versus 27.2%, OR 0.40, 95% CI: 0.26-0.61; P<0.0001). The use of chlorhexidine-impregnated dressing was associated with a trend towards reduction in catheter-related bloodstream or CNS infections (2.2% versus 3.8%, OR 0.58, 95% CI: 0.29-1.14, P=0.11). Local cutaneous reactions to chlorhexidine-impregnated dressing were reported in 5.6% of the patients in three studies (OR 8.17, 95% CI: 1.19-56.14, P=0.04), and 96% of these reactions occurred in neonatal patients. The number needed to prevent one episode of intravascular catheter-related bloodstream infection was 142 for an average period of catheter in situ of 10 days and a change of dressing every 5 days. The cost of preventing one vascular catheter-related bloodstream infection was estimated to be pound298 (US$532.5).
  
  
  CONCLUSIONS
  Chlorhexidine-impregnated dressing is effective in reducing vascular and epidural catheter bacterial colonization and is also associated with a trend towards reduction in catheter-related bloodstream or CNS infections. A large randomized controlled trial is needed to confirm whether chlorhexidine-impregnated dressing is cost-effective in preventing bacterial infection related to vascular and epidural catheters.
authors.affiliation: Department of Intensive Care, Royal Perth Hospital Perth 6000, Western Australia, Australia. kwok.ho@health.wa.gov.au
authors.forename: Kwok M
authors.initials: KM
authors.lastname: Ho
authors.forename: Edward
authors.initials: E
authors.lastname: Litton
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D001424:Bacterial Infections / Q000517:prevention & control*; D001458:Bandages; D002408:Catheters, Indwelling / Q000382:microbiology*; D002710:Chlorhexidine / Q000494:pharmacology*; D006801:Humans; D007297:Inpatients
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine