Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years
Background 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. M...
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| Veröffentlicht in: | Intensive care medicine 2019-06, Vol.45 (6), p.823-833 |
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| creator | Eggimann, Philippe Pagani, Jean-Luc Dupuis-Lozeron, Elise MS, Bruce Ekholm Thévenin, Marie-Josèphe Joseph, Christine Revelly, Jean-Pierre Que, Yok-Ai |
| description | Background
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.
Methods
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.
Results
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
|
| doi_str_mv | 10.1007/s00134-019-05617-x |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6534662</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A724267491</galeid><sourcerecordid>A724267491</sourcerecordid><originalsourceid>FETCH-LOGICAL-c494x-78c7f75088bb20f5ffc3d0f4cfbb2c3b3f86ac9af051fd84a5bbc737812aff973</originalsourceid><addsrcrecordid>eNp9ks1u1DAUhSMEokPhBVggS2zYuPgvcbJBqiooSJVYAGvLca4TV4ld7KSdeQpegWfhyerplP6gEfLCsv2dc6-vTlG8puSIEiLfJ0IoF5jQBpOyohKvnxQrKjjDlPH6abEiXDAsKsEOihcpnWdcViV9Xhxw0jSyFGxV_Pq2pFk7Dx2K0C1mdsGjYJHR8wAzRKxTCsbpOQPtGEKX5gh6Qs5buIETunLzgMAP2huYwM8P5ahdfDcCajfIDGOIA6xdl6uhLkJKzvcJhcuMUfrn9wZ0TC-LZ1aPCV7d7ofFj08fv598xmdfT7-cHJ9hIxqxxrI20sqS1HXbMmJLaw3viBXG5rPhLbd1pU2jLSmp7Wqhy7Y1ksuaMm1tI_lh8WHne7G0E3Qm9x31qC6im3TcqKCdevzi3aD6cKmqkouqYtng3a1BDD8XSLOaXDIwjtpDWJJijFLOykrQjL79Bz0PS_T5e1uK1JSUhN1TvR5B5fmGXNdsTdWxZIJVUjRbL7yH6sFDbjJ4sC5fP-KP9vB5dTA5s1fAdgITQ0oR7N1MKFHb2Kld7FSOnbqJnVpn0ZuH07yT_M1ZBvgOSPnJ9xDvR_Af22ujN-eL</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2210810502</pqid></control><display><type>article</type><title>Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Eggimann, Philippe ; Pagani, Jean-Luc ; Dupuis-Lozeron, Elise ; MS, Bruce Ekholm ; Thévenin, Marie-Josèphe ; Joseph, Christine ; Revelly, Jean-Pierre ; Que, Yok-Ai</creator><creatorcontrib>Eggimann, Philippe ; Pagani, Jean-Luc ; Dupuis-Lozeron, Elise ; MS, Bruce Ekholm ; Thévenin, Marie-Josèphe ; Joseph, Christine ; Revelly, Jean-Pierre ; Que, Yok-Ai</creatorcontrib><description>Background
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.
Methods
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.
Results
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.
Conclusions
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.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-019-05617-x</identifier><identifier>PMID: 30997542</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject><![CDATA[Aged ; Analysis ; Anesthesiology ; Anti-Infective Agents, Local - pharmacology ; Anti-Infective Agents, Local - therapeutic use ; Bandages - standards ; Bundling ; Catheter-Related Infections - drug therapy ; Catheter-Related Infections - epidemiology ; Catheter-Related Infections - prevention & control ; Catheters ; Central Venous Catheters - adverse effects ; Central Venous Catheters - microbiology ; Central Venous Catheters - statistics & numerical data ; Chlorhexidine ; Chlorhexidine - pharmacology ; Chlorhexidine - therapeutic use ; Critical Care Medicine ; Dressings ; Emergency Medicine ; Female ; Health aspects ; Humans ; Hypersensitivity ; Infection ; Infections ; Intensive ; Intensive care ; Intensive Care Units - organization & administration ; Intensive Care Units - statistics & numerical data ; Length of Stay - statistics & numerical data ; Male ; Medical instruments ; Medicine ; Medicine & Public Health ; Middle Aged ; Original ; Pain Medicine ; Patient Care Bundles - methods ; Patient Care Bundles - standards ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Poisson density functions ; Prospective Studies ; Reduction ; Regression analysis ; Regression models ; Sepsis - drug therapy ; Sepsis - epidemiology ; Sepsis - prevention & control ; Simplified Acute Physiology Score ; Skin ; Statistical analysis ; Switzerland - epidemiology]]></subject><ispartof>Intensive care medicine, 2019-06, Vol.45 (6), p.823-833</ispartof><rights>The Author(s) 2019</rights><rights>COPYRIGHT 2019 Springer</rights><rights>Intensive Care Medicine is a copyright of Springer, (2019). All Rights Reserved. © 2019. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c494x-78c7f75088bb20f5ffc3d0f4cfbb2c3b3f86ac9af051fd84a5bbc737812aff973</citedby><cites>FETCH-LOGICAL-c494x-78c7f75088bb20f5ffc3d0f4cfbb2c3b3f86ac9af051fd84a5bbc737812aff973</cites><orcidid>0000-0002-2615-6615</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-019-05617-x$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-019-05617-x$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30997542$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eggimann, Philippe</creatorcontrib><creatorcontrib>Pagani, Jean-Luc</creatorcontrib><creatorcontrib>Dupuis-Lozeron, Elise</creatorcontrib><creatorcontrib>MS, Bruce Ekholm</creatorcontrib><creatorcontrib>Thévenin, Marie-Josèphe</creatorcontrib><creatorcontrib>Joseph, Christine</creatorcontrib><creatorcontrib>Revelly, Jean-Pierre</creatorcontrib><creatorcontrib>Que, Yok-Ai</creatorcontrib><title>Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>Background
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.
Methods
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.
Results
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.
Conclusions
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.</description><subject>Aged</subject><subject>Analysis</subject><subject>Anesthesiology</subject><subject>Anti-Infective Agents, Local - pharmacology</subject><subject>Anti-Infective Agents, Local - therapeutic use</subject><subject>Bandages - standards</subject><subject>Bundling</subject><subject>Catheter-Related Infections - drug therapy</subject><subject>Catheter-Related Infections - epidemiology</subject><subject>Catheter-Related Infections - prevention & control</subject><subject>Catheters</subject><subject>Central Venous Catheters - adverse effects</subject><subject>Central Venous Catheters - microbiology</subject><subject>Central Venous Catheters - statistics & numerical data</subject><subject>Chlorhexidine</subject><subject>Chlorhexidine - pharmacology</subject><subject>Chlorhexidine - therapeutic use</subject><subject>Critical Care Medicine</subject><subject>Dressings</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Hypersensitivity</subject><subject>Infection</subject><subject>Infections</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive Care Units - organization & administration</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Male</subject><subject>Medical instruments</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original</subject><subject>Pain Medicine</subject><subject>Patient Care Bundles - methods</subject><subject>Patient Care Bundles - standards</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Poisson density functions</subject><subject>Prospective Studies</subject><subject>Reduction</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Sepsis - drug therapy</subject><subject>Sepsis - epidemiology</subject><subject>Sepsis - prevention & control</subject><subject>Simplified Acute Physiology Score</subject><subject>Skin</subject><subject>Statistical analysis</subject><subject>Switzerland - epidemiology</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9ks1u1DAUhSMEokPhBVggS2zYuPgvcbJBqiooSJVYAGvLca4TV4ld7KSdeQpegWfhyerplP6gEfLCsv2dc6-vTlG8puSIEiLfJ0IoF5jQBpOyohKvnxQrKjjDlPH6abEiXDAsKsEOihcpnWdcViV9Xhxw0jSyFGxV_Pq2pFk7Dx2K0C1mdsGjYJHR8wAzRKxTCsbpOQPtGEKX5gh6Qs5buIETunLzgMAP2huYwM8P5ahdfDcCajfIDGOIA6xdl6uhLkJKzvcJhcuMUfrn9wZ0TC-LZ1aPCV7d7ofFj08fv598xmdfT7-cHJ9hIxqxxrI20sqS1HXbMmJLaw3viBXG5rPhLbd1pU2jLSmp7Wqhy7Y1ksuaMm1tI_lh8WHne7G0E3Qm9x31qC6im3TcqKCdevzi3aD6cKmqkouqYtng3a1BDD8XSLOaXDIwjtpDWJJijFLOykrQjL79Bz0PS_T5e1uK1JSUhN1TvR5B5fmGXNdsTdWxZIJVUjRbL7yH6sFDbjJ4sC5fP-KP9vB5dTA5s1fAdgITQ0oR7N1MKFHb2Kld7FSOnbqJnVpn0ZuH07yT_M1ZBvgOSPnJ9xDvR_Af22ujN-eL</recordid><startdate>20190601</startdate><enddate>20190601</enddate><creator>Eggimann, Philippe</creator><creator>Pagani, Jean-Luc</creator><creator>Dupuis-Lozeron, Elise</creator><creator>MS, Bruce Ekholm</creator><creator>Thévenin, Marie-Josèphe</creator><creator>Joseph, Christine</creator><creator>Revelly, Jean-Pierre</creator><creator>Que, Yok-Ai</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-2615-6615</orcidid></search><sort><creationdate>20190601</creationdate><title>Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years</title><author>Eggimann, Philippe ; Pagani, Jean-Luc ; Dupuis-Lozeron, Elise ; MS, Bruce Ekholm ; Thévenin, Marie-Josèphe ; Joseph, Christine ; Revelly, Jean-Pierre ; Que, Yok-Ai</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c494x-78c7f75088bb20f5ffc3d0f4cfbb2c3b3f86ac9af051fd84a5bbc737812aff973</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Analysis</topic><topic>Anesthesiology</topic><topic>Anti-Infective Agents, Local - pharmacology</topic><topic>Anti-Infective Agents, Local - therapeutic use</topic><topic>Bandages - standards</topic><topic>Bundling</topic><topic>Catheter-Related Infections - drug therapy</topic><topic>Catheter-Related Infections - epidemiology</topic><topic>Catheter-Related Infections - prevention & control</topic><topic>Catheters</topic><topic>Central Venous Catheters - adverse effects</topic><topic>Central Venous Catheters - microbiology</topic><topic>Central Venous Catheters - statistics & numerical data</topic><topic>Chlorhexidine</topic><topic>Chlorhexidine - pharmacology</topic><topic>Chlorhexidine - therapeutic use</topic><topic>Critical Care Medicine</topic><topic>Dressings</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Hypersensitivity</topic><topic>Infection</topic><topic>Infections</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive Care Units - organization & administration</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Male</topic><topic>Medical instruments</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original</topic><topic>Pain Medicine</topic><topic>Patient Care Bundles - methods</topic><topic>Patient Care Bundles - standards</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Poisson density functions</topic><topic>Prospective Studies</topic><topic>Reduction</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Sepsis - drug therapy</topic><topic>Sepsis - epidemiology</topic><topic>Sepsis - prevention & control</topic><topic>Simplified Acute Physiology Score</topic><topic>Skin</topic><topic>Statistical analysis</topic><topic>Switzerland - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Eggimann, Philippe</creatorcontrib><creatorcontrib>Pagani, Jean-Luc</creatorcontrib><creatorcontrib>Dupuis-Lozeron, Elise</creatorcontrib><creatorcontrib>MS, Bruce Ekholm</creatorcontrib><creatorcontrib>Thévenin, Marie-Josèphe</creatorcontrib><creatorcontrib>Joseph, Christine</creatorcontrib><creatorcontrib>Revelly, Jean-Pierre</creatorcontrib><creatorcontrib>Que, Yok-Ai</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eggimann, Philippe</au><au>Pagani, Jean-Luc</au><au>Dupuis-Lozeron, Elise</au><au>MS, Bruce Ekholm</au><au>Thévenin, Marie-Josèphe</au><au>Joseph, Christine</au><au>Revelly, Jean-Pierre</au><au>Que, Yok-Ai</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2019-06-01</date><risdate>2019</risdate><volume>45</volume><issue>6</issue><spage>823</spage><epage>833</epage><pages>823-833</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><abstract>Background
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.
Methods
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.
Results
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.
Conclusions
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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30997542</pmid><doi>10.1007/s00134-019-05617-x</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-2615-6615</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Intensive care medicine, 2019-06, Vol.45 (6), p.823-833 |
| issn | 0342-4642 1432-1238 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6534662 |
| source | MEDLINE; SpringerLink Journals |
| subjects | Aged Analysis Anesthesiology Anti-Infective Agents, Local - pharmacology Anti-Infective Agents, Local - therapeutic use Bandages - standards Bundling Catheter-Related Infections - drug therapy Catheter-Related Infections - epidemiology Catheter-Related Infections - prevention & control Catheters Central Venous Catheters - adverse effects Central Venous Catheters - microbiology Central Venous Catheters - statistics & numerical data Chlorhexidine Chlorhexidine - pharmacology Chlorhexidine - therapeutic use Critical Care Medicine Dressings Emergency Medicine Female Health aspects Humans Hypersensitivity Infection Infections Intensive Intensive care Intensive Care Units - organization & administration Intensive Care Units - statistics & numerical data Length of Stay - statistics & numerical data Male Medical instruments Medicine Medicine & Public Health Middle Aged Original Pain Medicine Patient Care Bundles - methods Patient Care Bundles - standards Patients Pediatrics Pneumology/Respiratory System Poisson density functions Prospective Studies Reduction Regression analysis Regression models Sepsis - drug therapy Sepsis - epidemiology Sepsis - prevention & control Simplified Acute Physiology Score Skin Statistical analysis Switzerland - epidemiology |
| title | Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years |
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