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Dermatological Safety of Chlorhexidine-Impregnated Dressings in Paediatric Intensive Care: A Randomised Clinical
Francisco Javier Portero-Prados1,2, Manuel Pabón-Carrasco3, José Antonio Ponce-Blandón3
1Red Cross Nursing School, University of Seville, Seville, Spain.
Insights
Chlorhexidine gluconate (CHG)-impregnated dressings are safe for paediatric intensive care patients, reducing catheter-related bloodstream infections (CRBSIs). However, CHG dressings are linked to skin reactions in younger infants, necessitating careful monitoring.
Area of Science:
- Paediatric intensive care
- Infection prevention and control
- Dermatology
Background:
- Central venous catheters (CVCs) are vital in paediatric intensive care units (PICUs).
- CVCs are associated with significant risks, including catheter-related bloodstream infections (CRBSIs) and skin complications.
- Chlorhexidine gluconate (CHG)-impregnated dressings offer potential for reducing infection risks but raise concerns about dermatological safety in neonates and infants.
Purpose of the Study:
- To assess the dermatological safety of CHG-impregnated dressings in critically ill children requiring CVCs.
- To evaluate the impact of CHG dressings on catheter-related outcomes, including CRBSI incidence and catheter maintenance.
Main Methods:
- A single-blind, prospective randomized clinical trial was conducted in a tertiary PICU.
- Critically ill paediatric patients were randomized to receive either conventional transparent dressings or 2% CHG gel pad dressings.
- Primary outcome: tegumentary alterations at the catheter insertion site; Secondary outcomes: CRBSI incidence and catheter maintenance variables.
Main Results:
- No significant difference in overall skin alterations between CHG and conventional dressing groups (11.2% vs. 16.8%).
- CHG dressings were associated with significantly earlier onset of dermatological alterations and pruritus, particularly in younger children (p=0.003).
- CHG dressings led to fewer dressing changes, longer replacement intervals, and a significant reduction in CRBSI incidence (2.4% vs. 18.4%; p<0.001).
Conclusions:
- CHG-impregnated dressings demonstrate an acceptable dermatological safety profile in critically ill paediatric patients.
- CHG dressings improve catheter-related outcomes, notably reducing CRBSI rates, but require vigilant dermatological monitoring in infants due to age-dependent skin reactions.
- Findings support the use of CHG dressings for safer CVC management in PICUs, balancing infection prevention with skin integrity.
Background:
Central venous catheters are essential in paediatric intensive care but are associated with catheter-related bloodstream infections (CRBSIs) and skin complications. Chlorhexidine gluconate (CHG)-impregnated dressings may reduce infection risk; however, concerns remain regarding their dermatological safety in vulnerable paediatric populations.
Aim:
To evaluate the dermatological safety of CHG-impregnated dressings in critically ill paediatric patients requiring central venous catheters and to explore their impact on catheter-related outcomes.
Study Design:
A single-blind, prospective randomised clinical trial was conducted in a tertiary paediatric intensive care unit. Within routine clinical practice, patients were randomly assigned to receive either a conventional transparent dressing or a dressing incorporating a 2% CHG gel pad. The primary outcome was the occurrence of tegumentary alterations at the catheter insertion site. Secondary outcomes included CRBSI incidence and catheter maintenance variables.
Results:
Skin alterations were identified in 14.0% of patients, with no significant differences between groups (16.8% vs. 11.2%; p = 0.202). However, dermatological alterations occurred at a significantly younger age in the CHG group (6.5 ± 4.8 vs. 46.0 ± 43.2 months; p = 0.003), with a similar pattern for pruritus. Multivariable analysis showed a significant interaction between dressing type and age, indicating age-dependent dermatological responses. CHG dressings were associated with fewer dressing changes and longer intervals between replacements. CRBSI incidence was lower in the CHG group (2.4% vs. 18.4%; p < 0.001), although this was a secondary outcome.
Conclusions:
CHG-impregnated dressings showed an acceptable dermatological safety profile. Their use was associated with improved catheter-related outcomes, although skin reactions occurred at younger ages.
Relevance To Clinical Practice:
CHG dressings may support safer catheter management but require careful dermatological monitoring in infants. These findings may help inform dressing selection and catheter care strategies in paediatric intensive care settings where infection prevention and skin integrity must be balanced.
