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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 (, bcamins@dom.wustl.edu)
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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

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