title: Effect of chlorhexidine/silver sulfadiazine-impregnated central venous catheters in an intensive care unit with a low blood stream infection rate after implementation of an educational program: a before-after trial.
abstract: BACKGROUND
  Current guidelines recommend using antiseptic- or antibiotic-impregnated central venous catheters (CVCs) if, following a comprehensive strategy to prevent catheter-related blood stream infection (CR-BSI), infection rates remain above institutional goals based on benchmark values. The purpose of this study was to determine if chlorhexidine/silver sulfadiazine-impregnated CVCs could decrease the CR-BSI rate in an intensive care unit (ICU) with a low baseline infection rate.
  
  
  METHODS
  Pre-intervention and post-intervention observational study in a 24-bed surgical/trauma/burn ICU from October, 2002 to August, 2005. All patients requiring CVC placement after March, 2004 had a chlorhexidine/silver sulfadiazine-impregnated catheter inserted (post-intervention period).
  
  
  RESULTS
  Twenty-three CR-BSIs occurred in 6,960 catheter days (3.3 per 1,000 catheter days)during the 17-month control period. After introduction of chlorhexidine/silver sulfadiazine-impregnated catheters, 16 CR-BSIs occurred in 7,732 catheter days (2.1 per 1,000 catheter days; p = 0.16). The average length of time required for an infection to become established after catheterization was similar in the two groups (8.4 vs. 8.6 days; p = 0.85). Chlorhexidine/silver sulfadiazine-impregnated catheters did not result in a statistically significant change in the microbiological profile of CR-BSIs, nor did they increase the incidence of resistant organisms.
  
  
  CONCLUSIONS
  Although chlorhexidine/silver sulfadiazine-impregnated catheters are useful in specific patient populations, they did not result in a statistically significant decrease in the CR-BSI rate in this study, beyond what was achieved with education alone.
authors: Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors: Douglas J E
authors: DJ
authors: Schuerer
authors: Jeanne E
authors: JE
authors: Zack
authors: James
authors: J
authors: Thomas
authors: Ingrid B
authors: IB
authors: Borecki
authors: Carrie S
authors: CS
authors: Sona
authors: Marilyn E
authors: ME
authors: Schallom
authors: Melissa
authors: M
authors: Venker
authors: Jennifer L
authors: JL
authors: Nemeth
authors: Myrna R
authors: MR
authors: Ward
authors: Linda
authors: L
authors: Verjan
authors: David K
authors: DK
authors: Warren
authors: Victoria J
authors: VJ
authors: Fraser
authors: John E
authors: JE
authors: Mazuski
authors: Walter A
authors: WA
authors: Boyle
authors: Timothy G
authors: TG
authors: Buchman
authors: Craig M
authors: CM
authors: Coopersmith
mesh_terms: D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology*; D002710:Chlorhexidine / Q000008:administration & dosage; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D016469:Fungemia / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012837:Silver Sulfadiazine / Q000008:administration & dosage
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine; D012837:Silver Sulfadiazine