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Published on: July 13, 2019
Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and
Itzhak Levy1, Jacob Katz, Ester Solter
1Department of Pediatric Infectious Diseases, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel. lavyguy@bezeqint.net
Background:
Infections of short term, nontunneled, intravascular catheters are often caused by migration of organisms from the insertion site. The aim of this study was to evaluate the effectiveness and safety of a chlorhexidine gluconate-impregnated dressing for the reduction of central venous catheter (CVC) colonization and CVC-associated bloodstream infections in infants and children after cardiac surgery.
Methods:
This prospective, randomized, controlled study was conducted in the pediatric cardiac intensive care unit of a tertiary care pediatric medical center. Patients 0-18 years of age who were admitted to the pediatric cardiac intensive care unit during a 14-month period and required a CVC for >48 hours were randomized to receive a transparent polyurethane insertion site dressing (control group) or a chlorhexidine gluconate-impregnated sponge (Biopatch) dressing covered by a transparent polyurethane dressing (study group). The main outcome measures were rates of bacterial colonization, rates of CVC-associated bloodstream infections and adverse events.
Results:
Seventy-one patients were randomized to the control group and 74 to the study group. There were no significant between group differences in age, sex, Pediatric Risk of Mortality score or cardiac severity score. CVC colonization occurred in 21 control patients (29%) and 11 (14.8%) study patients (P = 0.0446; relative risk, 0.6166; 95% confidence interval, 0.3716-1.023). Bloodstream infection occurred in 3 patients (4.2%) in the control group and 4 patients (5.4%) in the study group. Local redness was noted in 1 control patient and 4 study group patients.
Conclusions:
The chlorhexidine gluconate-impregnated sponge is safe and significantly reduces the rates of CVC colonization in infants and children after cardiac surgery.
Insights
A chlorhexidine gluconate-impregnated dressing significantly reduced central venous catheter (CVC) colonization in pediatric cardiac surgery patients. This dressing is safe and effective for preventing CVC infections in this vulnerable population.
Area of Science:
- Pediatric critical care medicine
- Infectious disease prevention
- Medical device-associated infections
Background:
- Central venous catheter (CVC) infections often stem from organism migration from insertion sites.
- Evaluating interventions to reduce CVC colonization and associated bloodstream infections is crucial in pediatric cardiac surgery patients.
Purpose of the Study:
- To assess the efficacy and safety of a chlorhexidine gluconate-impregnated dressing.
- To determine its impact on CVC colonization and bloodstream infections in pediatric cardiac surgery patients.
Main Methods:
- A prospective, randomized, controlled study in a pediatric cardiac intensive care unit.
- Patients requiring CVC for >48 hours were randomized to a chlorhexidine-impregnated dressing or a standard dressing.
- Outcomes included bacterial colonization, CVC-associated bloodstream infections, and adverse events.
Main Results:
- CVC colonization rates were significantly lower in the chlorhexidine group (14.8%) compared to the control group (29%).
- No significant difference in CVC-associated bloodstream infection rates was observed between groups.
- Local redness was slightly more frequent in the chlorhexidine group but not statistically significant.
Conclusions:
- Chlorhexidine gluconate-impregnated dressings are safe for pediatric cardiac surgery patients.
- These dressings significantly reduce the rate of CVC colonization in this population.
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