Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-30T20:27:47.807Z Has data issue: false hasContentIssue false
  • English
  • Français

A Crossover Intervention Trial Evaluating the Efficacy of a Chlorhexidine-Impregnated Sponge in Reducing Catheter-Related Bloodstream Infections among Patients Undergoing Hemodialysis

Published online by Cambridge University Press:  02 January 2015

Bernard C. Camins ,
Amy M. Richmond ,
Kathrin L. Dyer ,
Heather N. Zimmerman ,
Daniel W. Coyne ,
Marcos Rothstein  and
Victoria J. Fraser
Bernard C. Camins*
Affiliation:
Division of Infectious Diseases, St Louis, Missouri
Amy M. Richmond
Affiliation:
Department of Medicine, Washington University School of Medicine, and Department of Hospital Epidemiology and Infection Control, Barnes-Jewish Hospital), St Louis, Missouri
Kathrin L. Dyer
Affiliation:
Division of Infectious Diseases, St Louis, Missouri
Heather N. Zimmerman
Affiliation:
Division of Infectious Diseases, St Louis, Missouri
Daniel W. Coyne
Affiliation:
Renal Division, St Louis, Missouri
Marcos Rothstein
Affiliation:
Renal Division, St Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, St Louis, Missouri
*
Division of Infection Diseases, 660 South Euclid Avenue, Box 8051, Saint Louis, MO 63110-1093 (, [email protected])
Get access Rights & Permissions [Opens in a new window]

Extract

Background.

Catheter-related bloodstream infections (CRBSIs) account for the majority of hemodialysis-related infections. There are no published data on the efficacy of the chlorhexidine-impregnated foam dressing at reducing the rate of CRBSI among patients undergoing hemodialysis.

Design.

A prospective, nonblinded, crossover intervention trial to determine the efficacy of a chlorhexidine-impregnated foam dressing to reduce the rate of CRBSI among patients undergoing hemodialysis.

Setting.

Two outpatient dialysis centers.

Patients.

A total of 121 patients who underwent dialysis through tunneled central venous catheters received the intervention during the trial.

Methods.

The primary outcome of interest was the incidence of CRBSI. A nested cohort study of all patients who received the chlorhexidine-impregnated foam dressing was also conducted. Backward stepwise logistic regression analysis was used to determine independent risk factors for development of CRBSI.

Results.

Thirty-seven CRBSIs occurred in the intervention group, for an incidence of 6.3 CRBSIs per 1,000 dialysis sessions, and 30 CRBSIs occurred in the control group, an incidence of 5.2 CRBSIs per 1,000 dialysis sessions (risk ratio, 1.22 [95% confidence interval {CI}, 0.75-1.97]; P = .46). The chlorhexidine-impregnated foam dressing was well tolerated, with only 2 patients (<2%) experiencing dermatitis that led to its discontinuation. The only independent risk factor for development of CRBSI was dialysis treatment at one dialysis center (adjusted odds ratio, 4.4 [95% CI, 1.77-13.65]; P = .002). Age of at least 60 years (adjusted odds ratio, 0.28 [95% CI, 0.09-0.82]; P = .02) was associated with lower risk of CRBSI.

Conclusions.

The use of a chlorhexidine-impregnated foam dressing did not decrease the incidence of CRBSI among patients with tunneled central venous catheters who were undergoing hemodialysis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 11 , November 2010 , pp. 1118 - 1123
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Causes of death. USRDS. United States renal data system. Am J Kidney Dis 1997;30(2 Suppl 1):S107–S17.Google Scholar
2.Mailloux, LU, Bellucci, AG, Wilkes, BM, et al.Mortality in dialysis patients: analysis of the causes of death. Am J Kidney Dis 1991;18(3):326–335.CrossRefGoogle ScholarPubMed
3.Taylor, G, Gravel, D, Johnston, L, Embil, J, Holton, D, Paton, S. Prospective surveillance for primary bloodstream infections occurring in Canadian hemodialysis units. Infect Control Hosp Epidemiol 2002;23(12):716–720.CrossRefGoogle ScholarPubMed
4.Saeed Abdulrahman, I, Al-Mueilo, SH, Bokhary, HA, Ladipo, GOA, Al-Rubaish, A. A prospective study of hemodialysis access-related bacterial infections. J Infect Chemother 2002;8(3):242–246.CrossRefGoogle ScholarPubMed
5.Stevenson, KB, Adcox, MJ, Mallea, MC, Narasimhan, N, Wagnild, JP. Standardized surveillance of hemodialysis vascular access infections: 18-month experience at an outpatient, multifacility hemodialysis center. Infect Control Hosp Epidemiol 2000;21(3):200–203.Google Scholar
6.Maki, DG, Cobb, L, Garman, JK, Shapiro, JM, Ringer, M, Helgerson, RB. An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial. Am J Med 1988;85(3):307–314.Google Scholar
7.Levin, A, Mason, AJ, Jindal, KK, Fong, IW, Goldstein, MB. Prevention of hemodialysis subclavian vein catheter infections by topical povidone-iodine. Kidney Int 1991;40(5):934–938.CrossRefGoogle ScholarPubMed
8.Shapiro, JM, Bond, EL, Garman, JK. Use of a Chlorhexidine dressing to reduce microbial colonization of epidural catheters. Anesthesiology 1990;73(4):625–631.CrossRefGoogle ScholarPubMed
9.Garland, JS, Alex, CP, Mueller, CD, et al.A randomized trial comparing povidone-iodine to a Chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics 2001;107(6):1431–1436.CrossRefGoogle ScholarPubMed
10.Chambers, ST, Sanders, I, Patton, WN, et al.Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release Chlorhexidine dressings: results from a prospective randomized controlled trial. J Hosp Infect 2005;61(1):53–61.CrossRefGoogle ScholarPubMed
11.Timsit, IF, Schwebel, C, Bouadma, L, et al.Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 2009;301(12):1231–1241.Google Scholar
12.Garner, JS, Jarvis, WR, Emori, TG, Horan ??, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16(3):128–140.Google Scholar
13.Lok, CE, Stanley, KE, Hux, JE, Richardson, R, Tobe, SW, Conly, J. Hemodialysis infection prevention with polysporin ointment. J Am Soc Nephrol 2003;14(1):169–179.Google Scholar
14.Johnson, DW, MacGinley, R, Kay, TD, et al.A randomized controlled trial of topical exit site mupirocin application in patients with tunnelled, cuffed haemodialysis catheters. Nephrol Dial Transplant 2002;17(10):1802–1807.Google Scholar
15.Johnson, DW, van, EC, Mudge, DW, et al.Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus mupirocin for the prevention of catheter-associated infections in hemodialysis patients. J Am Soc Nephrol 2005;16(5):1456–1462.CrossRefGoogle ScholarPubMed
16.Oliver, MJ, Rothwell, DM, Fung ?, ??? JE, Lok, CE. Late creation of vascular access for hemodialysis and increased risk of sepsis. J Am Soc Nephrol 2004;15(7):1936–1942.Google Scholar
17.Abbott, KC, Agodoa, LY. Etiology of bacterial septicemia in chronic dialysis patients in the United States. Clin Nephrol 2001;56(2):124–131.Google ScholarPubMed
18.Powe, NR, Jaar, B, Furth, SL, Hermann, J, Briggs, W. Septicemia in dialysis patients: incidence, risk factors, and prognosis. Kidney Int 1999;55(3):1081–1090.CrossRefGoogle ScholarPubMed
19.Jaar, BG, Hermann, JA, Furth, SL, Briggs, W, Powe, NR. Septicemia in diabetic hemodialysis patients: comparison of incidence, risk factors, and mortality with nondiabetic hemodialysis patients. Am J Kidney Dis 2000;35(2):282–292.Google Scholar