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Dressing disruption is a major risk factor for catheter-related infections*

Timsit, Jean-François MD, PhD; Bouadma, Lila MD, PhD; Ruckly, Stéphane MSc; Schwebel, Carole MD, PhD; Garrouste-Orgeas, Maïté MD; Bronchard, Régis MD; Calvino-Gunther, Silvia RN; Laupland, Kevin MD; Adrie, Christophe MD, PhD; Thuong, Marie MD; Herault, Marie-Christine MD; Pease, Sebastian MD; Arrault, Xavier PharmD; Lucet, Jean-Christophe MD, PhD

doi: 10.1097/CCM.0b013e31824e0d46
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Objective: Major catheter-related infection includes catheter-related bloodstream infections and clinical sepsis without bloodstream infection resolving after catheter removal with a positive quantitative tip culture. Insertion site dressings are a major mean to reduce catheter infections by the extraluminal route. However, the importance of dressing disruptions in the occurrence of major catheter-related infection has never been studied in a large cohort of patients.

Design: A secondary analysis of a randomized multicenter trial was performed in order to determine the importance of dressing disruption on the risk for development of catheter-related bloodstream infection.

Measurements and Main Results: Among 1,419 patients (3,275 arterial or central-vein catheters) included, we identified 296 colonized catheters, 29 major catheter-related infections, and 23 catheter-related bloodstream infections. Of the 11,036 dressings changes, 7,347 (67%) were performed before the planned date because of soiling or undressing. Dressing disruption occurred more frequently in patients with higher Sequential Organ Failure Assessment scores and in patients receiving renal replacement therapies; it was less frequent in males and patients admitted for coma. Subclavian access protected from dressing disruption. Dressing cost (especially staff cost) was inversely related to the rate of disruption. The number of dressing disruptions was related to increased risk for colonization of the skin around the catheter at removal (p < .0001). The risk of major catheter-related infection and catheter-related bloodstream infection increased by more than three-fold after the second dressing disruption and by more than ten-fold if the final dressing was disrupted, independently of other risk factors of infection.

Conclusion: Disruption of catheter dressings was common and was an important risk factor for catheter-related infections. These data support the preferential use of the subclavian insertion site and enhanced efforts to reduce dressing disruption in postinsertion bundles of care.

From the University Joseph Fourrier (J-FT, SR, SC-G, KL), Albert Bonniot Institute, La Tronche Cedex, France; Medical Intensive Care Unit (J-FT, CS, SC-G), University hospital A Michallon, Grenoble, France; Medical Intensive Care Unit (LB), Bichat—Claude Bernard University Hospital, Paris, France; Medical–Surgical Intensive Care Unit (MG-O), Saint Joseph Hospital Network, Paris, France; Surgical Intensive Care Unit (RB), Bichat—Claude Bernard University Hospital, Paris, France; Critical Care Medicine (KL), Peter Lougheed Centre and University of Calgary, Calgary, Alberta, Canada; Delafontaine Hospital (CA), Saint Denis, France; National Biomedecine Agency (MT), Saint Denis la Plaine, France; Department of Physiology (CA, MT), University of René Descartes, Cochin University Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; Mixed Surgical Intensive Care Unit (M-CH), University hospital A Michallon, Grenoble, France; Surgical Intensive Care Unit (SP), Beaujon University Hospital, Clichy, France; Department of Pharmacy (XA), Bichat Claude Bernard Hospital, Paris, France; and Infection Control Unit (J-CL), Bichat—Claude Bernard University Hospital, Assistance-Publique Hôpitaux de Paris, and University Paris VII Denis Diderot, Paris, France

*See also p. 1962.

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The dressing study was entirely funded by the French Ministry of Health (Projet Hospitalier de Recherche Clinique 2005-PHN01).

Currently listed as NCT 00417235.

Ethicon provided all the chlorhexidine-impregnated sponges free of cost. Neither the French Ministry of Health nor Ethicon had any role in designing the study, collecting or analyzing the data, or deciding to publish the results.

Dr. Timsit received research grants from 3-M company and Johnson & Johnson. Dr. Timsit received lecture fees from 3-M and Carefusion companies.

Dr. Timsit conceived the study design and coordinated the data-capture, the data-cleaning, the statistical analysis, and the revision of the final manuscript. Drs. Bouadma, Orgeas, Bronchard, Herault, and Pease enrolled patients into the study. Dr. Laupland contributed to the study design and to the revision of the final manuscript. Drs. Thuong and Adrie participated to the advisory board and contributed to the manuscript revision. Mr. Arrault coordinated the safety monitoring committee. Mr. Ruckly performed the statistical analysis. Miss Gunther coordinated the research monitors activities, data cleaning, and participated in manuscript revision. Mr. Lucet conceived the study design and contributed to final manuscript revision. All the authors read and approved the final manuscript.

Drs. Timsit and Lucet consulted for 3-M and Carefusion, and received honoraria from 3-M and Ethicon. The remaining authors have not disclosed any potential conflicts of interest.

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© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins