Objective: To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter–related colonization and catheter-related bloodstream infection using meta-analysis.
Data Sources: Multiple computerized database searches supplemented by manual searches including relevant conference proceedings.
Study Selection: Randomized controlled trials evaluating the efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and catheter-related bloodstream infection.
Data Extraction: Data were extracted on patient and catheter characteristics and outcomes.
Data Synthesis: Nine randomized controlled trials met the inclusion criteria. Use of a chlorhexidine-impregnated dressing resulted in a reduced prevalence of catheter-related bloodstream infection (random effects relative risk, 0.60; 95% CI, 0.41–0.88, p = 0.009). The prevalence of catheter colonization was also markedly reduced in the chlorhexidine-impregnated dressing group (random effects relative risk, 0.52; 95% CI, 0.43–0.64; p < 0.001). There was significant benefit for prevention of catheter colonization and catheter-related bloodstream infection, including arterial catheters used for hemodynamic monitoring. Other than in low birth weight infants, adverse effects were rare and minor.
Conclusions: Our analysis shows that a chlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and, more importantly, catheter-related bloodstream infection and warrants routine use in patients at high risk of catheter-related bloodstream infection and central venous catheter or arterial catheter colonization.
1William S. Middleton Memorial Veterans Hospital, Madison, WI.
2Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI.
3Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
4Biostatistical Consulting Unit, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB.
* See also p. 1742.
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Presented, in part, at the Annual Meeting of the Society for Healthcare Epidemiology, Atlanta, GA, 2010.
Dr. Safdar is supported by grant number AG40669 from the National Institute on Aging, National Institutes of Health, and a VA MERIT grant. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Address requests for reprints to: Nasia Safdar, MD, PhD, Department of Medicine, University of Wisconsin Medical School, MFCB 5221, 1685 Highland Avenue, Madison, WI 53705. E-mail: firstname.lastname@example.org