Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years.

Details

Serval ID
serval:BIB_DF96B4DC9E06
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years.
Journal
Intensive care medicine
Author(s)
Eggimann P., Pagani J.L., Dupuis-Lozeron E., Ms B.E., Thévenin M.J., Joseph C., Revelly J.P., Que Y.A.
ISSN
1432-1238 (Electronic)
ISSN-L
0342-4642
Publication state
Published
Issued date
06/2019
Peer-reviewed
Oui
Volume
45
Number
6
Pages
823-833
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Prospective randomized controlled studies have demonstrated that addition of chlorhexidine (CHG) dressings reduces the rate of catheter (central venous and arterial)-associated bloodstream infections (CABSIs). However, studies confirming their impact in a real-world setting are lacking.
We conducted a real-world data study evaluating the impact of incrementally introducing chlorhexidine dressings (sponge or gel) in addition to an ongoing catheter bundle on the rates of CABSI, expressed as incidence density rates per 1000 catheter-days measured as part of a surveillance program. Poisson regression models were used to compare infection rates over time. Both dressings were used simultaneously during one of the five study periods.
From 2006 to 2014, 18,286 patients were admitted (91,292 ICU-days and 155,242 catheter-days). We recorded 111 CABSIs. We observed a progressive but significant decrease of CABSI rates from 1.48 (95% CI 1.09-2.01) without CHG dressings to 0.69 (95% CI 0.43-1.09) and 0.23 (95% CI 0.11-0.48) episodes per 1000 catheter-days when CHG sponge and CHG gel dressings were used (p = 0.0007; p < 0.001). A non-significant lower rate of infections occurred with CHG gel compared with CHG sponge dressings. An identical low rate of allergic skin reactions (0.3/1000 device-days) was observed with both types of CHX dressings. Post-study data until 2018 confirmed a sustained decrease of infection rates over 11 years.
The addition of chlorhexidine dressings to all CVC and arterial lines to an ongoing catheter bundle was associated with a sustained 11-year reduction of all catheter-associated bloodstream infections. This large real-world data study further supports the current recommendations for the systematic use of CHG dressings on all catheters of ICU patients.
Keywords
Aged, Anti-Infective Agents, Local/pharmacology, Anti-Infective Agents, Local/therapeutic use, Bandages/standards, Catheter-Related Infections/drug therapy, Catheter-Related Infections/epidemiology, Catheter-Related Infections/prevention & control, Central Venous Catheters/adverse effects, Central Venous Catheters/microbiology, Central Venous Catheters/statistics & numerical data, Chlorhexidine/pharmacology, Chlorhexidine/therapeutic use, Female, Humans, Intensive Care Units/organization & administration, Intensive Care Units/statistics & numerical data, Length of Stay/statistics & numerical data, Male, Middle Aged, Patient Care Bundles/methods, Patient Care Bundles/standards, Prospective Studies, Sepsis/drug therapy, Sepsis/epidemiology, Sepsis/prevention & control, Simplified Acute Physiology Score, Switzerland/epidemiology, Bacteremia, Catheter bundle, Catheter-related infections, Central line-associated bloodstream infections, Chlorhexidine gel, Chlorhexidine sponge, Chlorhexidine-dressing, Nosocomial infection
Pubmed
Web of science
Open Access
Yes
Create date
05/05/2019 15:49
Last modification date
28/02/2020 7:19
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