Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to page options Skip directly to site content

Updated Recommendations on the Use of Chlorhexidine-Impregnated Dressings for Prevention of Intravascular Catheter-Related Infections (2017)

Appendix: Table 4.
Strength of Evidence for Using C-I Gel Dressings or C-I Sponge under Standard Dressings vs. Using Highly Adhesive Dressing or Standard Dressing Alone among Patients Aged ≥ 18 Years with Short-term, Non-tunneled Central Venous Catheters A

Outcome Findings Quantity and Type of Evidence
(Sample Size)
GRADE of Evidence for Outcome
(Limitations of the Evidence)
CRBSI B
  • 3 RCTs found that C-I dressings decreased rates of CRBSI.
    • 1 multicenter RCT1 (N=1,879) of ICU patients with CVCs, arterial catheters, or both compared transparent C-I gel dressing with either highly adhesive transparent dressing alone or standard, breathable, hypoallergenic dressing alone; HR for CVCs and arterial catheters combined: 0.40 (CI: 0.19–0.87); p=0.02; HR for CVC only: 0.30 (CI: 0.10–0.92); p=0.04. The study found no difference in CRBSI rates by dressing type among patients with arterial catheters: HR: 0.51 (CI: 0.15–1.74); p=0.28. Patients in these 3 analyses may have concurrently used multiple CVCs, multiple arterial catheters, or both.
    • 1 multicenter RCT2 (N=1,636) of ICU patients with CVCs, arterial catheters, or both, compared C-I sponge under semipermeable, transparent dressing with semipermeable, transparent dressing alone; HR: 0.24 (CI: 0.09–0.65); p<0.01. This study did not stratify results by catheter type.
    • 1 single-center RCT3 (N=601) of hematology-oncology unit patients with chlorhexidine and silver sulfadiazine-impregnated CVC compared C-I sponge under standard, sterile, transparent wound dressing with standard, sterile, transparent wound dressing alone; RR: 0.54 (CI: 0.31–0.94); p=0.02.
  • 1 multicenter RCT4 (N=306) of ICU patients with CVCs compared C-I sponge under transparent, semipermeable, polyurethane, occlusive dressing with transparent, semipermeable, polyurethane, occlusive dressing alone; found no difference in CRBSI rates by dressing type: HR: 1.65 (CI: 0.27–10.01); p=0.59.
4 RCTs1-4

(N=4,422)

High
(None)
CRIB
  • 2 large multicenter RCTs in ICUs found that use of C-I dressings decreased rates of CRI.
    • 1 multicenter RCT1 (N=1,879) of ICU patients with CVCs, arterial catheters, or both compared transparent C-I gel dressing with highly adhesive transparent dressing alone or standard, breathable, hypoallergenic dressing alone; HR (arterial catheters and CVCs): 0.33 (CI: 0.17–0.62); p< 0.01; HR (for CVCs): 0.27 (CI: 0.11–0.66); p=<0.01. The study found no difference in CRI rates by dressing type among patients with arterial catheters: HR: 0.39 (CI: 0.15–1.03); p=0.06. Patients in these 3 analyses may have concurrently used multiple CVCs, multiple arterial catheters, or both.
    • 1 multicenter RCT2 (N=1,636) of ICU patients with CVCs, arterial catheters, or both, compared C-I sponge under semipermeable, transparent dressing with semipermeable, transparent dressing alone; HR: 0.39 (0.16–0.93); p=0.03. This study did not stratify results by catheter type.
    • 2 smaller RCTs found no difference in CRI rates by dressing type.
  • 1 multicenter RCT4 (N=306) of ICU patients with CVCs compared C-I sponge under transparent, semipermeable, polyurethane, occlusive dressing with transparent, semipermeable, polyurethane, occlusive dressing alone; HR: 0.65 (CI: 0.23–1.85); p=0.42.
  • 1 single-center RCT5 (N=32) of ICU patients with CVCs compared C-I sponge under occlusive dressing with occlusive dressing alone; incidence (per catheter): 1/17 vs. 0/16; p=NS.
4 RCTs1,2,4,5

(N=3,853)

Moderate
(Imprecise C)
Product-related adverse events
  • 2 RCTs1,2 of ICU patients with CVCs, arterial catheters, or both, found no systemic adverse reactions to chlorhexidine.
  • 1 multicenter RCT1 (N=1,879) of ICU patients with CVCs, arterial catheters, or both, compared transparent C-I gel dressing with highly adhesive transparent dressing or standard, breathable, hypoallergenic dressing; incidence (per patient) of severe contact dermatitis: 22/938 (2.3%) vs. 5/941 (0.5%); p<0.01. Rate of abnormal ICDRG score: 2.3% vs. 1%; p<0.01
  • 1 multicenter RCT2 (N=1,525) of ICU patients with CVCs, arterial catheters, or both compared C-I sponge under semipermeable, transparent dressing with semipermeable, transparent dressing alone. Severe contact dermatitis occurred in 8 patients (10.4/patient or 5.3/1000 catheters) that required permanent removal of the C-I dressing. (Severe contact dermatitis in patients with standard dressings not reported.) Rate of abnormal ICDRG score (events/catheter): 100/6,720 (1.49%) vs. 63/5,875 (1.02%); p=0.02
  • 1 multicenter RCT4 (N=306) of ICU patients with CVCs compared C-I sponge under transparent, semipermeable, polyurethane, occlusive dressing with transparent, semipermeable, polyurethane, occlusive dressing alone; suggested all patients tolerated C-I sponge well; none were excluded due to allergy to C-I sponge.
  • 1 single-center RCT3 (N=601) of hematology-oncology unit patients with chlorhexidine and silver sulfadiazine-impregnated triple-lumen CVC compared C-I sponge under standard, sterile, transparent wound dressing with the standard, sterile, transparent wound dressing alone; found no product-related adverse events associated with either dressing type.
4 RCTs1-4

(N=4,311)

Moderate
(Imprecise D)
Chlorhexidine resistance
  • 1 multicenter RCT2 (N=1,525) of ICU patients with CVCs, arterial catheters, or both compared C-I sponge under semipermeable, transparent dressing with semipermeable, transparent dressing alone; found no difference by dressing type in median minimum bactericidal concentration (MBC): 4 (IQR 4–16) vs. 4 (IQR 4–8).
  • 1 single-center RCT3 (N=601) of hematology-oncology unit patients in which all patients received chlorhexidine and silver sulfadiazine impregnated CVCs compared C-I sponge under standard, sterile, transparent wound dressing with standard, sterile, transparent wound dressing alone; suggested no differences in bacterial resistance by dressing type.
2 RCTs2,3

(N=2,126)

Low
(Imprecise E)

Footnotes

  1. The overall strength of evidence for this comparison is Moderate. The overall strength of evidence for a comparison is determined by the lowest GRADE of Evidence for a Critical Outcome in that comparison.
  2. A critical outcome
  3. Inconsistent results and inconsistent outcome definitions.
  4. Low number of events.
  5. Low number of events; no difference between study group

References

  1. Timsit JF, Mimoz O, Mourvillier B, et al. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med. 2012;186(12):1272-1278.
  2. Timsit JF, 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. 2009;301(12):1231-1241.
  3. Ruschulte H, Franke M, Gastmeier P, et al. Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: a randomized controlled trial. Ann Hematol. 2009;88(3):267-272.
  4. Arvaniti K, Lathyris D, Clouva-Molyvdas P, et al. Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: a multicenter, randomized, controlled study. Crit Care Med. 2012;40(2):420-429.
  5. Roberts B, Cheung D. Biopatch–a new concept in antimicrobial dressings for invasive devices. Aust Crit Care. 1998;11(1):16-19.
TOP