title: Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults.
abstract: BACKGROUND
  Most vascular catheter-related infections (CRIs) occur extraluminally in patients in the intensive care unit (ICU). Chlorhexidine-impregnated and strongly adherent dressings may decrease catheter colonization and CRI rates.
  
  
  OBJECTIVE
  To determine if chlorhexidine-impregnated and strongly adherent dressings decrease catheter colonization and CRI rates.
  
  
  METHODS
  In a 2:1:1 assessor-masked randomized trial in patients with vascular catheters inserted for an expected duration of 48 hours or more in 12 French ICUs, we compared chlorhexidine dressings, highly adhesive dressings, and standard dressings from May 2010 to July 2011. Coprimary endpoints were major CRI with or without catheter-related bloodstream infection (CR-BSI) with chlorhexidine versus nonchlorhexidine dressings and catheter colonization rate with highly adhesive nonchlorhexidine versus standard nonchlorhexidine dressings. Catheter-colonization, CR-BSIs, and skin reactions were secondary endpoints.
  
  
  RESULTS
  A total of 1,879 patients (4,163 catheters and 34,339 catheter-days) were evaluated. With chlorhexidine dressings, the major-CRI rate was 67% lower (0.7 per 1,000 vs. 2.1 per 1,000 catheter-days; hazard ratio [HR], 0.328; 95% confidence interval [CI], 0.174-0.619; P = 0.0006) and the CR-BSI rate 60% lower (0.5 per 1,000 vs. 1.3 per 1,000 catheter-days; HR, 0.402; 95% CI, 0.186-0.868; P = 0.02) than with nonchlorhexidine dressings; decreases were noted in catheter colonization and skin colonization rates at catheter removal. The contact dermatitis rate was 1.1% with and 0.29% without chlorhexidine. Highly adhesive dressings decreased the detachment rate to 64.3% versus 71.9% (P < 0.0001) and the number of dressings per catheter to two (one to four) versus three (one to five) (P < 0.0001) but increased skin colonization (P < 0.0001) and catheter colonization (HR, 1.650; 95% CI, 1.21-2.26; P = 0.0016) without influencing CRI or CR-BSI rates.
  
  
  CONCLUSIONS
  A large randomized trial demonstrated that chlorhexidine-gel-impregnated dressings decreased the CRI rate in patients in the ICU with intravascular catheters. Highly adhesive dressings decreased dressing detachment but increased skin and catheter colonization. Clinical trial registered with www.clinicaltrials.gov (NCT 01189682).
authors.affiliation: Université Grenoble 1 (Joseph Fourrier)-U823 "Outcome of Cancers and Critical Illness," Albert Bonniot Institute, 38076, La Tronche, France. jftimsit@chu-grenoble.fr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
authors.forename: Olivier
authors.initials: O
authors.lastname: Mimoz
authors.forename: Bruno
authors.initials: B
authors.lastname: Mourvillier
authors.forename: Bertrand
authors.initials: B
authors.lastname: Souweine
authors.forename: Maïté
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Serge
authors.initials: S
authors.lastname: Alfandari
authors.forename: Gaétan
authors.initials: G
authors.lastname: Plantefeve
authors.forename: Régis
authors.initials: R
authors.lastname: Bronchard
authors.forename: Gilles
authors.initials: G
authors.lastname: Troche
authors.forename: Remy
authors.initials: R
authors.lastname: Gauzit
authors.forename: Marion
authors.initials: M
authors.lastname: Antona
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Canet
authors.forename: Julien
authors.initials: J
authors.lastname: Bohe
authors.forename: Alain
authors.initials: A
authors.lastname: Lepape
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.forename: Xavier
authors.initials: X
authors.lastname: Arrault
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.forename: Caroline
authors.initials: C
authors.lastname: Tournegros
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lucet
mesh_terms: D000269:Adhesives / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use; D055499:Catheter-Related Infections / Q000382:microbiology / Q000517:prevention & control*; D062905:Central Venous Catheters / Q000009:adverse effects* / Q000382:microbiology; D002710:Chlorhexidine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016638:Critical Illness; D003877:Dermatitis, Contact / Q000209:etiology; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009779:Occlusive Dressings; D012867:Skin / Q000382:microbiology; D018709:Statistics, Nonparametric
chemical_list: D000269:Adhesives; D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine