title: Chlorhexidine gluconate-impregnated central-line dressings and necrosis in complicated skin disorder patients.
abstract: Although chlorhexidine gluconate (CHG) disks have been shown to help reduce the incidence of central line-associated blood stream infections, their use can result in local skin necrosis. The effects of CHG disks on patients with complex skin pathology have not been studied. We report 6 cases of dermal necrosis associated with Biopatch (Ethicon Inc, Somerville, NJ) CHG disks in adults with complex skin pathology including those with Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, burns, and anasarca. All patients had a CHG disk placed at a central venous catheter insertion site. Age range was from 21 to 84 years. Discovery of the reaction ranged from 4 to 14 days after disk placement. Resultant skin erosions required 2 to 10 weeks to reepithelialize. Complicated skin disorder patients represent a rare subset of the critically ill who appear prone to CHG disk necrosis. Continuous contact of CHG under occlusive dressings is speculated to predispose Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, and burn patients to local chemical injury secondary to loss of the epithelial tissue barrier, decreased cohesion of the epidermal-dermal junction, and increased tissue permeability. In these patients, the risk of placing the CHG disk may present more risk than using alternative antimicrobial dressings.
authors.affiliation: Division of Burn, Trauma, Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Division of Dermatology, Brigham and Women's Hospital, Boston, MA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA. Electronic address: jwall1@partners.org.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Wall
authors.affiliation: Division of Burn, Trauma, Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Division of Dermatology, Brigham and Women's Hospital, Boston, MA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Sherrie J
authors.initials: SJ
authors.lastname: Divito
authors.affiliation: Division of Burn, Trauma, Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA; Division of Dermatology, Brigham and Women's Hospital, Boston, MA; Division of Plastic Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA.
authors.forename: Simon G
authors.initials: SG
authors.lastname: Talbot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D001458:Bandages; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002710:Chlorhexidine / Q000009:adverse effects / Q000031:analogs & derivatives*; D016638:Critical Illness; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013262:Stevens-Johnson Syndrome / Q000209:etiology*; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; C010882:chlorhexidine gluconate; D002710:Chlorhexidine
keywords: Burn; Central line–associated blood stream infections (CLABSIs); Chlorhexidine gluconate (CHG) disk; Graft vs host disease (GvHD); Stevens-Johnson syndrome (SJS); Toxic epidermal necrolysis (TENS)