Chlorhexidine-impregnated transparent dressings decrease catheter-related infections in hemodialysis patients: a quality improvement project.
OBJECTIVE
Central venous catheters (CVC) are associated with increased infection rates, morbidity and mortality compared to other hemodialysis vascular access. Chlorhexidine-impregnated transparent (CHG-transparent) dressings allow for continuous antimicrobial exposure and easy visibility of the CVC insertion site. We conducted a quality improvement project to compare catheter-related infection (CRI) rates in two dressing regimens - CHG-transparent dressings and adhesive dry gauze dressing in hemodialysis patients with tunneled CVCs.


METHODS
The study was conducted in two phases. In phase 1, CHG-transparent dressing was introduced to EDC hemodialysis unit, while EDG and EDN hemodialysis units, served as the control sites and maintained adhesive dry gauze dressing. Phase 2 of the study involved replacing the adhesive dry gauze dressing with CHG-transparent dressing at EDG and EDN and maintaining CHG-transparent dressing at EDC. CRI rates at each hemodialysis unit during the 12-month intervention were compared to CRI rates for the 12-month pre-intervention period for each study phase. CRI rates were also compared between all three hemodialysis units.


RESULTS
In phase 1, CRI rates (per 1000 days) in EDC (intervention site) decreased by 52% (1.69 vs. 0.82, p<0.05) and increased by 12% (1.80 vs. 2.02, p = 0.75) at EDG, and 35% (0.91 vs. 1.23, p = 0.40) at EDN. In phase 2, CRI rates at EDG and EDN (intervention sites) decreased by 86% (1.86 vs. 0.26 p<0.05), and 53% (1.89 vs. 0.88, p<0.05), respectively, and decreased by 20% at EDC (0.73 vs. 0.58, p = 0.65).


CONCLUSIONS
Replacing adhesive dry gauze dressing with CHG-transparent dressing for hemodialysis patients with tunneled CVC was associated with decreased CRI rates.
Emory University School of Medicine, Atlanta, Georgia - USA.
Ibironke W
IW
Apata
Rollins School of Public Health, Emory University, Atlanta, Georgia - USA.
John
J
Hanfelt
Emory University School of Medicine, Atlanta, Georgia - USA.
James L
JL
Bailey
Emory University School of Medicine, Atlanta, Georgia - USA.
Vandana Dua
VD
Niyyar
D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001458:Bandages / Q000009:adverse effects; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000592:standards; D002408:Catheters, Indwelling / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002710:Chlorhexidine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D005845:Georgia; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D006435:Renal Dialysis / Q000592:standards; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine