Chambers, S.T., Sanders, J., Patton, W.N., Ganly, P., Birch, M., Crump, J.A., & Spearing, R.L. (2005). Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: Results from a prospective randomized controlled trial. Journal of Hospital Infection, 61, 53–61.
The purpose of the study was to evaluate the efficacy of sustained-release chlorhexidine (CHX) dressings versus standard dressings.
All adult patients admitted under the hematology service that were to receive chemotherapy and had a tunneled cuffed central intravascular catheter inserted were eligible for inclusion. After insertion, all tunneled intravascular catheters were randomized, but they were treated in the same manner with a sterile gauze and porous adhesive dressings until the exit site was dry and free from ooze. Those randomized to standard catheter exit-site treatment (control group) received no dressing in accordance with BCHS guidelines. The CHX group (intervention group) were treated with CHX dressings consisting of a 2.5 cm hydrophilic polyurethane foam disk containing CHX gluconate in a sustained-release formulation. These were applied to the exit site as soon the oozing had stopped following intravascular catheter insertion, and changed as needed or weekly until the catheter was removed. The same treatment was continued for the life of the catheter but if an intravascular catheter was removed and replaced, the new catheter was randomized. Exit site and tunnels were routinely examined on a weekly basis.
The primary endpoint of this study was the development of exit-site and/or tunnel infection. The secondary endpoint was removal of the catheter for infection. In total, 114 tunneled intravascular catheters in 95 patients were randomized from August 1998 to December 2001.
A single-site inpatient hematology unit
Prospective, randomized
All patients received a 10F vascular catheter with a surecuff tissue ingrowth, vitacuff antimicrobial cuff inserted percutaneously by a radiologist using the Seldinger technique.
Definitions used:
This study has shown that the use of CHX dressings was associated with less exit site infections (OR = 0.13, 95% CI [0.04, 0.37], p < 0.001). The rate of premature catheter removal for these infections was reduced approximately three fold in the CHX group (OR = 0.23, 95% CI [0.07, 0.77]). The failures of the CHX dressing group were associated either with a very early occurrence after insertion of the catheter, suggesting that the infecting organisms were implanted at the time of catheter insertion, or with delays in application of the CHX dressing. Positive blood cultures occurred in fewer patients in the control group (p < 0.01) with less isolates of gram-positive organisms in the control group (p < 0.05).
This study demonstrated that use of the sustained-release CHX dressing was associated with reduced extralumenal catheter infections; however, it was not associated with fewer blood stream infections.
Sustained-release CHX dressings may help to reduce some central line-associated infections in patients with cancer who are at risk and in whom other aspects of catheter insertion and care are in place. Further well-designed research in this area is warranted.