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Benefit Found for Chlorhexidine Dressings

Such dressings significantly reduced the incidence of major intravascular catheter–related infections.

To decrease the incidence of intravascular catheter–related bloodstream infections in ICUs, medical centers have adopted such preventive strategies as using checklists, best-practice "bundles," and antimicrobial-impregnated catheters. Chlorhexidine gluconate–impregnated sponge (CHGIS) dressings have aroused great interest, but data to support this approach are limited.

In a recent multicenter, randomized, controlled, four-arm trial, investigators in France compared CHGIS dressings with standard ones and also compared routine 3-day with 7-day dressing changes. Participants were adult ICU patients between December 2006 and May 2008 who were expected to require an arterial catheter, a central venous catheter, or both for 48 hours. Pulmonary arterial, hemodialysis, and peripherally inserted central venous catheters were not included. All catheters in a given patient were managed in the same way; dressings were donated by the manufacturer.

A total of 1636 patients were included. Use of CHGIS dressings lowered the incidence of major catheter-related infection (CRI; i.e., catheter-related sepsis with or without bloodstream infection) from 1.4 to 0.6 per 1000 catheter-days (P=0.03), with no apparent emergence of chlorhexidine-resistant pathogens and only a minimal rate of contact dermatitis (2% in the CHGIS group and 1% in controls). Catheter colonization rates were similar between the 3-day and 7-day dressing-change groups; however, the frequency of dressing changes differed little between groups because of the need for unplanned changes.

Comment: Several aspects of this study may have affected the observed incidence of infections. For example, 46% of evaluated catheters were arterial, 36% were in a femoral location, and antimicrobial-impregnated catheters were excluded. In addition, the baseline CRI rate was very low (although it was calculated using a definition that is slightly different than the CDC’s). The observed 57% reduction in CRI incidence in this setting is striking and shows a major advantage to using CHGIS dressings, even in hospitals that have achieved low infection rates with other interventions.

— Richard T. Ellison III, MD

Published in Journal Watch Infectious Diseases April 1, 2009

Citation(s):

Timsit J-F et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: A randomized controlled trial. JAMA 2009 Mar 25; 301:1231.

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