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Efficacy of chlorhexidine patches on central line-associated bloodstream infections in children
Nattapong Jitrungruengnij1,2, Suvaporn Anugulruengkitt1,2, Thanapoom Rattananupong3
1Division of Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Chlorhexidine patches did not reduce central line-associated bloodstream infections (CLABSIs) in children compared to standard dressings. Enhanced CLABSI prevention bundles are necessary for pediatric care.
Area of Science:
- Pediatric infectious diseases
- Hospital-acquired infections
- Antimicrobial stewardship
Background:
- Central line-associated bloodstream infections (CLABSIs) are significant hospital-acquired infections.
- Chlorhexidine-impregnated dressings (CHG patches) have shown efficacy in reducing CLABSIs in adults.
- The effectiveness of CHG patches in pediatric populations requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of CHG patches in reducing CLABSIs in children aged 2 months to 18 years.
- To compare CLABSI rates between children using CHG patches and those using standard transparent dressings.
- To assess catheter colonization and local adverse effects associated with CHG patches.
Main Methods:
- An open-label randomized controlled trial was conducted with 192 pediatric patients requiring short-term catheters.
- Patients were randomized to receive either CHG patches or standard transparent dressings.
- CLABSIs were defined using National Healthcare Safety Network criteria, and catheter care followed APSIC recommendations.
Main Results:
- No significant difference in CLABSI incidence rates was observed between the CHG patch group (7.98 per 1,000 catheter days) and the standard dressing group (6.74 per 1,000 catheter days).
- The incidence rate ratio for CLABSIs was 1.18 (95% CI, 0.52-2.70), indicating no protective effect of CHG patches.
- Catheter colonization rates were similar, and only local adverse effects were reported in 6.8% of participants.
Conclusions:
- CHG patches did not demonstrate a reduction in CLABSI rates compared to standard transparent dressings in this pediatric study population.
- The findings suggest that current CLABSI prevention bundles may need strengthening for pediatric patients.
- Further research into comprehensive CLABSI prevention strategies for children is warranted.
Background:
Central line-associated bloodstream infections (CLABSIs) are important hospital-acquired infections. Chlorhexidine-impregnated dressings (also known as chlorhexidine patches, CHG patches) are reported to decrease CLABSIs in adults. This study aims to determine the efficacy of CHG patches in reducing CLABSIs in children.
Methods:
An open-label randomized controlled trial was conducted in children aged 2 months to 18 years, requiring a short-term catheter. Patients were randomized into two groups, allocated to receive CHG patches or standard transparent dressings. Care of the catheter was in accordance with Asia Pacific Society of Infection Control (APSIC) recommendations. Central-line-associated bloodstream infections were defined using National Healthcare Safety Network surveillance criteria.
Results:
From April 2017 to April 2018, 192 children were enrolled. There were 108 CHG patch catheters and 101 standard dressing catheters, contributing to 3,113 catheter days. The median duration of catheter dwelling was 13 days, with an interquartile range (IQR) of 8-20 days. Half were placed at the jugular vein and 22% at the femoral vein. There were 23 CLABSI events. Incidence rates for CHG patches and standard dressings were 7.98 (95% confidence interval (CI), 4.25-13.65) and 6.74 (95% CI, 3.23-12.39) per 1,000 catheter days, respectively (incidence rate ratio 1.18; 95% CI, 0.52-2.70). The CLABSI pathogens were 15 Gram-negative bacteria, six Gram-positive bacteria, and two Candida organisms. Catheter colonization of CHG patches and standard dressings were 2.02 (95% CI, 0.42-5.91) and 3.07 (95% CI, 1.00-7.16) per 1,000 catheter days, respectively. Only local adverse effects occurred in 6.8% of the participants.
Conclusions:
In our setting, there was no difference in CLABSI rates when the chlorhexidine patch dressings were compared with the standard transparent dressings. Strengthening of CLABSI prevention bundles is mandatory.
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