Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial
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The objective of the study was to evaluate the effectiveness of chlorhexidine-impregnated sponges for reducing catheter-related infections of central venous catheters inserted for cancer chemotherapy. The method used was a randomized, prospective, open, controlled clinical study (three-step group sequential analysis protocol). The patients were from two high dependency units at a university hospital undergoing chemotherapy for haematological or oncological malignancies requiring central venous catheters (CVCs) expected to remain in place for at least 5 days. Six hundred and one patients with 9,731 catheterization days were studied between January 2004 and January 2006. Patients admitted for chemotherapy received chlorhexidine and silver sulfadiazine-impregnated triple-lumen CVCs under standardized conditions and were randomized to the groups receiving a chlorhexidine gluconate-impregnated wound dressing or a standard sterile dressing. Daily routine included clinical assessment of the insertion site (swelling, pain, redness), temperature, white blood count and C-reactive protein. Catheters remained in place until they were no longer needed or when a CVC-related infection was suspected. Infection was confirmed with blood cultures via the catheter lumina and peripheral blood cultures according to the time-to-positivity method. Six hundred and one patients were included. The groups were comparable with respect to demographic and clinical data. The incidence of CVC-related infections were 11.3% (34 of 301) and 6.3% (19 of 300) in the control and chlorhexidine-impregnated wound dressing groups, respectively (p = 0.016, relative risk 0.54; confidence interval 0.31–0.94). Especially, catheter-related infections at internal jugular vein insertions could be reduced (p = 0.018). No adverse effects related to the intervention were observed. The use of chlorhexidine-impregnated wound dressings significantly reduced the incidence of CVC-related infections in patients receiving chemotherapy.
KeywordsCatheter-related bloodstream infection Neutropenia Central venous catheter Chlorhexidine Chemotherapy
The authors are especially indebted to the nurses at the Department of Haematology, Haemostasis, Oncology, and Stem Cell Transplantation at Hannover Medical School. The authors thank Christian Apfel M.D. for critical review of the manuscript.
Funding and conflict of interest statement
The study was carried out without any external funding. Part of the results of this study was presented as an abstract at the Annual Meeting of the European Society of Anaesthesiologists (ESA) in Madrid in June 2006. H.R. and M.F. received travel grants by Ethicon/Johnson & Johnson.
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