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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Prospective multicenter multinational cohort study: Time-to-central line-associated bloodstream infection with plain
Victor Daniel Rosenthal1, Zhilin Jin2, Ruijie Yin2
1Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, FL, USA.
Background:
Central line-associated bloodstream infections (CLABSIs) cause preventable harm. We evaluated whether Chlorhexidine/Silver Sulfadiazine (CH/SSD)-impregnated CVCs reduce the CLABSI hazard compared with plain CVCs using time-to-event methodology.
Methods:
A prospective cohort study was conducted in 6 hospitals in India, Malaysia, Papua New Guinea, and Turkey from 03/01/2023-10/31/2025. We included 1,294 plain-CVC patients and 456 CH/SSD-CVC patients. The primary endpoint was time to first CLABSI, estimated by Kaplan-Meier modeled with Cox proportional hazards regression. A prespecified landmark analysis assessed early risk at days 0-5.
Results:
Within 30 days, 51 CLABSIs occurred in the plain-CVC group and 12 in the CH/SSD group. Kaplan-Meier cumulative incidence at 30 CVC-days showed statistically significant separation (log-rank X2 = 5.309; P = .021). In the primary Cox proportional hazards model, CH/SSD-CVCs were associated with a significantly lower hazard of CLABSI than plain-CVCs (hazard ratio = 0.297; 95%CI = 0.134-0.658; P = .003). In the prespecified early 0-5-day period, 13 CLABSIs occurred in the plain-CVC group and 0 in the CH/SSD-CVC group (log-rank X2 = 4.923; P = .026). ICU mortality was higher in the plain-CVC group (28.3% vs 18.4%; P < .001).
Conclusions:
CH/SSD-CVCs were associated with a significant reduction in the CLABSI hazard, supporting further study of their use as tools to prevent CLABSI.
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