Chlorhexidine-Impregnated Sponges and Less Frequent Dressing Changes for Prevention of Catheter-Related Infections in Critically Ill Adults

摘要: Context Use of a chlorhexidine gluconate–impregnated sponge (CHGIS) in intravascular catheter dressings may reduce catheter-related infections (CRIs). Changing every 3 days be more frequent than necessary. Objective To assess superiority CHGIS regarding the rate major CRIs (clinical sepsis with or without bloodstream infection) and noninferiority (less 3% colonization-rate increase) 7-day vs 3-day dressing changes. Design, Setting, Patients Assessor-blind, 2 × 2 factorial, randomized controlled trial conducted from December 2006 through June 2008 recruiting patients 7 intensive care units university 2 general hospitals France. were adults (>18 years) expected to require an arterial catheter, central-vein both inserted for 48 hours longer. Interventions standard (controls). Scheduled change unsoiled adherent days, immediate any soiled leaking dressings. Main Outcome Measures Major comparison control dressings; colonization 3- Results Of 2095 eligible patients, 1636 (3778 catheters, 28 931 catheter-days) could evaluated. The median duration insertion was 6 (interquartile range [IQR], 4-10) days. There no interaction between interventions. decreased rates (10/1953 [0.5%], 0.6 per 1000 catheter-days 19/1825 [1.1%], 1.4 catheter-days; hazard ratio [HR], 0.39 [95% confidence interval {CI}, 0.17-0.93]; P = .03) (6/1953 0.40 17/1825 1.3 HR, 0.24 CI, 0.09-0.65]). not associated greater resistance bacteria skin samples at removal. Severe CHGIS-associated contact dermatitis occurred 8 (5.3 catheters). prevented 1 CRI 117 catheters. Catheter 142 1657 catheters (7.8%) group (10.4 168 1828 (8.6%) (11.0 catheter-days), mean absolute difference 0.8% (95% −1.78% 2.15%) (HR, 0.99; 95% 0.77-1.28), indicating number changes 4 (IQR, 3-6) 2-5) (P  Conclusions unit reduced risk infection even when background low. Reducing frequency changing modestly reduces total appears safe. Trial Registration clinicaltrials.gov Identifier: NCT00417235