Table 5

Appendix - Updated Recommendations on the Use of Chlorhexidine-Impregnated Dressings for Prevention of Intravascular Catheter-Related Infections (2017)
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Appendix: Table 5.
Strength of Evidence for Using C-I Sponges under Standard Dressings vs. Using Standard Dressings or Gauze among Patients Aged < 18 Years with Short-term, Non-tunneled Central Venous Catheters F

Outcome type, findings, quantity and type of evidence for patients under 18.
Outcome Findings Quantity and Type of Evidence(Sample Size) GRADE of Evidence for Outcome(Limitations of the Evidence)
CRBSIB
  • 1 multicenter RCT6 (N=705) of NICU patients with tunneled and non-tunneled CVCs compared C-I sponge under transparent polyurethane dressing with transparent polyurethane dressing alone; yielded a subanalysis of neonates with percutaneous [non-tunneled] CVCs (n=620) that found no difference in the rate of CRBSI by dressing type: RR: 1.2 (CI: 0.5–2.7); p=0.65.
  • 1 single-center RCT7 (N=100) of PICU patients aged 0–18 years with non-tunneled CVCs that compared C-I gel pad dressing with sterile gauze pad; suggested no statistically significant difference in the incidence of CRBSI by dressing type: 1/50 (2%) vs. 5/50 (10%); p > 0.05.
 2 RCTs6,7

(N=720)

 Very Low

(Indirect, G Imprecise H)
CABSIB
  • 1 single-center RCT (N=145) of pediatric and neonatal PCICU patients with non-tunneled CVCs compared C-I sponge under semipermeable dressing with semipermeable dressing alone; suggested no difference in the proportion of patients with CABSI by dressing type: 4/74 (5.4%) vs. 3/71 (4.2%); p=1.0.
 1 RCT8

(N=145)

 Low

(Imprecise I)
BSI without a source B
  • 1ulticenter RCT (N=705) of NICU patients with tunneled and non-tunneled CVCs that compared C-I sponge under transparent polyurethane dressing with transparent polyurethane dressing alone; yielded a subanalysis in neonates with percutaneous (non-tunneled) catheters (N=662) that suggested no difference in BSI without a source by dressing type: RR: 1.1 (0.8–1.7); p=0.44.
 1 RCT6

(N=662)

 Very Low

(Indirect G, Imprecise J)
Local catheter infection B
  • 1 single-center RCT (N=100) of PICU patients with non-tunneled CVCs that compared C-I gel pad dressing with sterile gauze pad; suggested no statistically significant difference in the incidence of local catheter infection per patient by dressing type: 1/50 (2%) vs. 2/50 (4%); p> 0.05.
 1 RCT7

(N=100)

 Low

(Imprecise I)
Product-related adverse events
  • 1 multicenter RCT6 (N=705) of NICU patients with tunneled or non-tunneled CVCs that compared C-I sponge under transparent polyurethane dressing with transparent polyurethane dressing alone; reported a higher incidence (per patient) of severe contact dermatitis among patients with sponge dressings: 19/335 (5.7%) vs. 0/370. In the C-I sponge group, 15/98 (15%) of patients weighing <1,000 grams developed dermatitis, compared with 4/237 (1.5%) of patients weighing ≥1,000 grams (p<0.01).
  • 1 single-center RCT8 (N=145) of pediatric and neonatal PCICU patients with non-tunneled CVC compared C-I sponge under transparent polyurethane dressing with transparent polyurethane dressing alone; suggested a higher incidence (per patient) of local redness in patients with sponge dressings: 4/74 (5.4%) vs. 1/71 (1.4%). All intervention events occurred in neonates.
 2 RCTs6,8

(N=850)

 Moderate

(Imprecise G)

Footnotes

B     A critical outcome
G     Different skin antisepsis used for each study group.
H     Wide confidence interval in one study, low power in second study.
I      Underpowered; only 1 study.
J      Only 1 study; wide confidence interval.

References

  1. 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.
  2. Duzkaya DS, Sahiner NC, Uysal G, Yakut T, Citak A. Chlorhexidine-Impregnated Dressings and Prevention of Catheter-Associated Bloodstream Infections in a Pediatric Intensive Care Unit. Crit Care Nurse. 2016;36(6):e1-e7.
  3. Levy I, Katz J, Solter E, et al. Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study. Pediatr Infect Dis J. 2005;24(8):676-679.
Page last reviewed: December 14, 2017
Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP)