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Effectiveness of chlorhexidine dressings to prevent catheter-related bloodstream infections. Does one size fit all? A systematic literature review and meta-analysis

Published online by Cambridge University Press:  16 September 2020

Mireia Puig-Asensio Open the ORCID record for Mireia Puig-Asensio [Opens in a new window] ,
Alexandre R. Marra ,
Christopher A. Childs ,
Mary E. Kukla ,
Eli N. Perencevich  and
Marin L. Schweizer
Mireia Puig-Asensio*
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
Alexandre R. Marra
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
Christopher A. Childs
Affiliation:
Hardin Library for the Health Sciences, University of Iowa Libraries, Iowa City, Iowa, United States
Mary E. Kukla
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States
Eli N. Perencevich
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
Marin L. Schweizer
Affiliation:
University of Iowa Carver College of Medicine, Iowa City, Iowa, United States Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, United States
*
Author for correspondence: Mireia Puig-Asensio, E-mail: [email protected]
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Abstract

Objective:

To evaluate the effectiveness of chlorhexidine (CHG) dressings to prevent catheter-related bloodstream infections (CRBSIs).

Design:

Systematic review and meta-analysis.

Methods:

We searched PubMed, CINAHL, EMBASE, and ClinicalTrials.gov for studies (randomized controlled and quasi-experimental trials) with the following criteria: patients with short- or long-term catheters; CHG dressings were used in the intervention group and nonantimicrobial dressings in the control group; CRBSI was an outcome. Random-effects models were used to obtain pooled risk ratios (pRRs). Heterogeneity was evaluated using the I2 test and the Cochran Q statistic.

Results:

In total, 20 studies (18 randomized controlled trials; 15,590 catheters) without evidence of publication bias and mainly performed in intensive care units (ICUs) were included. CHG dressings significantly reduced CRBSIs (pRR, 0.71; 95% CI, 0.58–0.87), independent of the CHG dressing type used. Benefits were limited to adults with short-term central venous catheters (CVCs), including onco-hematological patients. For long-term CVCs, CHG dressings decreased exit-site/tunnel infections (pRR, 0.37; 95% CI, 0.22–0.64). Contact dermatitis was associated with CHG dressing use (pRR, 5.16; 95% CI, 2.09–12.70); especially in neonates and pediatric populations in whom severe reactions occurred. Also, 2 studies evaluated and did not find CHG-acquired resistance.

Conclusions:

CHG dressings prevent CRBSIs in adults with short-term CVCs, including patients with an onco-hematological disease. CHG dressings might reduce exit-site and tunnel infections in long-term CVCs. In neonates and pediatric populations, proof of CHG dressing effectiveness is lacking and there is an increased risk of serious adverse events. Future studies should investigate CHG effectiveness in non-ICU settings and monitor for CHG resistance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 12 , December 2020 , pp. 1388 - 1395
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

ADDITIONAL PRESENTATION: Results from this study were accepted to be presented at the following scientific meetings: SHEA/CDC Decennial 6th International Conference on Healthcare Associated Infections and the 30th European Congress of Clinical Microbiology and Infectious Diseases.

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