Document Detail


Randomized Controlled Trial of Chlorhexidine Dressing and Highly Adhesive Dressing for Preventing Catheter-Related Infections in Critically Ill Adults.
MedLine Citation:
PMID:  23043083     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Rationale. Most vascular catheter-related infections (CRIs) occur extraluminally in ICU patients. Chlorhexidine-impregnated and strongly adherent dressings may decrease catheter colonization and CRI rates. Methods. In a 2:1:1 assessor-blinded randomized trial in patients with vascular catheters inserted for an expected duration of 48 hours or more in 12 French ICUs, we compared chlorhexidine dressings, highly adhesive dressings, and standard dressings, from May 2010 to July 2011. Co-primary endpoints were major-CRI with or without catheter-related bloodstream infection (CR-BSI) with chlorhexidine vs. non-chlorhexidine dressings and catheter colonization rate with highly adhesive non-chlorhexidine vs. standard non-chlorhexidine dressings. Catheter-colonization, CR-BSIs and skin reactions were secondary endpoints. Results. 1879 patients (4163 catheters, 34,339 catheter-days) were evaluated. With chlorhexidine dressings, the major-CRI rate was 67% lower (0.7/1000 vs. 2.1/1000 catheter-days; hazard ratio [HR], 0.328; 95% confidence interval [95%CI], 0.174-0.619 P=0.0006) and the CR-BSI rate 60% lower (0.5/1000 vs. 1.3/1000 catheter-days; HR, 0.402; 95%CI, 0.186-0.868, P=0.02) than with non-chlorhexidine dressings; decreases were noted in catheter colonization and skin colonization rates at catheter removal. The contact dermatitis rate was 1.1% with and 0.29% without chlorhexidine. Highly adhesive dressings decreased the detachment rate to 64.3% vs. 71.9% (P<0.0001) and the number of dressings per catheter to 2 (1-4) vs. 3 (1-5) (P<0.0001) but increased skin colonization (P<0.0001) and catheter colonization (HR=1.650; 95%CI, 1.21-2.26; P=0.0016) without influencing CRI or CR-BSI rates. Conclusion. A large randomized trial demonstrated that chlorhexidine-gel impregnated dressings decreased the CRI rate in ICU patients with intravascular catheters. Highly adhesive dressings decreased dressing detachment but increased skin and catheter colonization. Clinical trial registration information available at www.clinicaltrials.gov, i.d. NCT01189682.
Authors:
Jean François Timsit; Olivier Mimoz; Bruno Mourvillier; Bertrand Souweine; Maïté Garrouste-Orgeas; Serge Alfandari; Gaétan Plantefeve; Régis Bronchard; Gilles Troche; Remy Gauzit; Marion Antona; Emmanuel Canet; Julien Bohe; Alain Lepape; Aurélien Vesin; Xavier Arrault; Carole Schwebel; Christophe Adrie; Jean-Ralph Zahar; Stéphane Ruckly; Caroline Tournegros; Jean-Christophe Lucet
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-4
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  -     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Medical ICU, CHU A Michallon, Grenoble, France.
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