Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial.
2009
Context Use of a chlorhexidine gluconate–impregnated sponge (CHGIS) in intravascular
catheterdressings may reduce
catheter-related infections (CRIs). Changing
catheterdressings every 3 days may be more frequent than necessary. Objective To assess superiority of CHGIS dressings regarding the rate of major CRIs (clinical sepsis with or without bloodstream infection) and noninferiority (less than 3% colonization-rate increase) of 7-day vs 3-day dressing changes. Design, Setting, and Patients Assessor-blind, 2 × 2 factorial, randomized controlled trial conducted from December 2006 through June 2008 and recruiting patients from 7 intensive care units in 3 university and 2 general hospitals in France. Patients were adults (>18 years) expected to require an
arterial catheter, central-vein
catheter, or both inserted for 48 hours or longer. Interventions Use of CHGIS vs standard dressings (controls). Scheduled change of unsoiled adherent dressings every 3 vs every 7 days, with immediate change of any soiled or leaking dressings. Main Outcome Measures Major CRIs for comparison of CHGIS vs control dressings; colonization rate for comparison of 3- vs 7-day dressing changes. Results Of 2095 eligible patients, 1636 (3778
catheters, 28 931
catheter-days) could be evaluated. The median duration of
catheterinsertion was 6 (interquartile range [IQR], 4-10) days. There was no interaction between the interventions. Use of CHGIS dressings decreased the rates of major CRIs (10/1953 [0.5%], 0.6 per 1000
catheter-days vs 19/1825 [1.1%], 1.4 per 1000
catheter-days; hazard ratio [HR], 0.39 [95% confidence interval {CI}, 0.17-0.93]; P = .03) and
catheter-related bloodstream infections (6/1953
catheters, 0.40 per 1000
catheter-days vs 17/1825
catheters, 1.3 per 1000
catheter-days; HR, 0.24 [95% CI, 0.09-0.65]). Use of CHGIS dressings was not associated with greater resistance of bacteria in skin samples at
catheterremoval. Severe CHGIS-associated
contact dermatitisoccurred in 8 patients (5.3 per 1000
catheters). Use of CHGIS dressings prevented 1 major CRI per 117
catheters.
Cathetercolonization rates were 142 of 1657
catheters(7.8%) in the 3-day group (10.4 per 1000
catheter-days) and 168 of 1828
catheters(8.6%) in the 7-day group (11.0 per 1000
catheter-days), a mean
absolute differenceof 0.8% (95% CI, −1.78% to 2.15%) (HR, 0.99; 95% CI, 0.77-1.28), indicating noninferiority of 7-day changes. The median number of dressing changes per
catheterwas 4 (IQR, 3-6) in the 3-day group and 3 (IQR, 2-5) in the 7-day group (P Conclusions Use of CHGIS dressings with intravascular
cathetersin the intensive care unit reduced risk of infection even when background infection rates were low. Reducing the frequency of changing unsoiled adherent dressings from every 3 days to every 7 days modestly reduces the total number of dressing changes and appears safe. Trial Registration clinicaltrials.gov Identifier: NCT00417235
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