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.
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.
Schuerer
Douglas J E
DJ
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Zack
Jeanne E
JE
Thomas
James
J
Borecki
Ingrid B
IB
Sona
Carrie S
CS
Schallom
Marilyn E
ME
Venker
Melissa
M
Nemeth
Jennifer L
JL
Ward
Myrna R
MR
Verjan
Linda
L
Warren
David K
DK
Fraser
Victoria J
VJ
Mazuski
John E
JE
Boyle
Walter A
WA
Buchman
Timothy G
TG
Coopersmith
Craig M
CM
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
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine; D012837:Silver Sulfadiazine