Reduction of central venous line-associated bloodstream infection rates by using a chlorhexidine-containing dressing.
OBJECTIVE
The reduction of central venous line (CVL)-associated bloodstream infections (CLABSIs) is generally advocated. However, despite implementing infection prevention recommendations, CLABSI rates remain high at some institutions. Therefore, a chlorhexidine-containing dressing should be assessed for its potential for infection reduction, adverse events (AEs) and practicability.


METHODS
The number of CVLs, CVL days, CLABSIs and CLABSI rates with regard to the kind of dressing (standard vs. chlorhexidine-containing) were documented from November 2010 to may 2012 (1,298 patients with 12,220 CVL days) at two intensive care units (ICUs) and compared to historical controls. The practicability and safety of the chlorhexidine-containing dressing and reasons for not using this dressing were assessed.


RESULTS
Forty CLABSIs occurred in 34 patients, resulting in a significantly lower overall CLABSI rate in patients with the chlorhexidine-containing dressing [1.51/1,000 CVL days; confidence interval (CI): 0.75-2.70] compared to patients with the standard dressing (5.87/1,000 CVL days; CI: 3.93-8.43; p < 0.0001). The CLABSI rate in historical controls receiving the standard dressing was 6.2/1,000 CVL days. The main reason for not using chlorhexidine-containing dressing was bleeding at the insertion site. AEs occurred in five patients and represented self-healing skin macerations (3 cases) and superficial skin necrosis (2 cases).


CONCLUSIONS
In case of high CLABSI rates despite the implementation of standard recommendations, our findings suggest that a chlorhexidine-containing dressing safely decreases CLABSI rates.
Department of Infection Control and Infectious Diseases, University Hospital Aachen, RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany, sscheithauer@ukaachen.de.
S
S
Scheithauer
K
K
Lewalter
J
J
Schröder
A
A
Koch
H
H
Häfner
V
V
Krizanovic
K
K
Nowicki
R-D
RD
Hilgers
S W
SW
Lemmen
D000368:Aged; D001458:Bandages; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002710:Chlorhexidine / Q000627:therapeutic use*; D004202:Disinfectants / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged
D004202:Disinfectants; D002710:Chlorhexidine