A Randomized Controlled Study: Can Chlorhexidine-Impregnated Dressings Prevent Central Venous

Catheter Associated Bloodstream Infections in the Pediatric Intensive Care Unit?

1Dr. Duygu Sönmez Düzkaya, 2Yrd. Doç. Dr. Nejla Canbulat Şahiner, 3Hem. Tülay Yakut, 4Yrd. Doç. Dr. Gülzade Uysal, 3Prof. Dr. Agop Çıtak

1Istanbul University, Istanbul Faculty of Medicine, Directorate of Nursing Services, Turkey2Karamanoğlu Mehmet Bey University, Nursing Department, Turkey3Istanbul University, Istanbul Faculty of Medicine, Pediatric Intensive Care Unit, Turkey4Okan University School of HealthSciences, Turkey

BACKGROUND

• Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates prolong hospital length of stay (LOS) and increase medical costs.

Aim

• To compare the efficacy of chlorhexidine impregnated dressing with standard dressings solution in preventing catheter-related bloodstream infection.

Methods

• This prospective, randomized, controlled experimental study was undertaken in a university hospital’s pediatric intensive care unit (PICU) between December 2012, and January 2014.

• The trial was approved by the Ethics Committee.

Methods

• In total, 100 patients were enrolled into the study;

• 50 patients with chlorhexidine impregnated dressings (chlorhexidine group), and

• 50 patients with standard dressings (standard group).

Methods

Inclusion criteria;• Patient age of between 1 mounth-18year old,• Provided the treating physician felt the

inserted catheter would be present for a minimum of 72h.,

• CVCs inserted in PICU• Don’t use neuromuscular-blocking drugs• Have volunteered to participate in the study.

Methods

• Standard group;• The dressings of the standard group were changed

in accordance with standard clinical care. • Each patient’s skin was disinfected with a 10%

povidone-iodine solution 3 min and allowed to dry.

Methods

• Chlorhexidine group;• Catheter care Each patient’s skin was disinfected

with a 10% povidone-iodine solution 3min and allowed to dry.

• The chlorhexidine group’s dressings were changed every seven days.

Methods

• Both group;– Installing or removing a central venous catheter

care guide use – The catheter was inserted to comply with aseptic

technique. – After inserting catheter whilethe patient's daily

body care was taken to wet the pad.– Daily follow-up form was performed.

Methods

• Catheter site was observed on a daily basis.

• Catheter blood cultures before retiring, the

catheter is pulled and sent to a laboratory

breeding status of peripheral blood cultures

were evaluated.

Defination Catheter tip Central Catheter

hemoculture Peripheral catheter blood cultures

Result

No growth No growth or the same patogen with peripheral blood culture

No growth or the same patogen with central catheter blood culture

Sterile catheter

Reproduction(<15 cfu)

No growth or different patogen with catheter tip

No growth Contamination

Reproduction (≥ 15 cfu)

different patogen with catheter tip

different patogen with catheter tip

Colonization

Reproduction ReproductionHe same patogen with catheter tip

No growth Catheter-related bloodstream infection

Signs of inflammation over the catheter entry semiquantitative culture of the catheter tip with 15 cfu local catheter infection in case of reproductive factors (LK)

Results

100 patient

50 standard group 50 chlorhexidine group

Randomization-Patients;- 53 % 1 mounth-1 year old,-60 % male, -32 % respiratory system diseases-56% were found to have additional disease

Results

Central Venous Catheter colonization

4 (%8) standard group 1 (%2) chlorhexidine group

(p>0, 05)

Results

Local catheter infection

5 (%10) standard group 4 (%8) chlorhexidine group

(p>0, 05)

Results

Catheter-related bloodstream infection

5 (%10) standard group 1 (%2) chlorhexidine group

(p>0, 05)

Results

Catheter closure product

The duration of intensive care Duration of stay on mechanical ventilation The duration of the catheter

(p>0, 05)

CONCLUSIONS AND RECOMMENDATIONS

• 2% chlorhexidine impregnated dressings reduce the rates of CVC bloodstream infections and colonization in the pediatric intensive care unit.

• Although these results were not statistically significant, They are clinically important.

• It s recommended that 2% chlorhexidine impregnated dressings can used in PICU.

THANK YOU