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A Randomized Controlled Study: Can Chlorhexidine-Impregnated Dressings Prevent Central Venous
Catheter Associated Bloodstream Infections in the Pediatric Intensive Care Unit?
1Dr. Duygu Sönmez Düzkaya, 2Yrd. Doç. Dr. Nejla Canbulat Şahiner, 3Hem. Tülay Yakut, 4Yrd. Doç. Dr. Gülzade Uysal, 3Prof. Dr. Agop Çıtak
1Istanbul University, Istanbul Faculty of Medicine, Directorate of Nursing Services, Turkey2Karamanoğlu Mehmet Bey University, Nursing Department, Turkey3Istanbul University, Istanbul Faculty of Medicine, Pediatric Intensive Care Unit, Turkey4Okan University School of HealthSciences, Turkey
BACKGROUND
• Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates prolong hospital length of stay (LOS) and increase medical costs.
Aim
• To compare the efficacy of chlorhexidine impregnated dressing with standard dressings solution in preventing catheter-related bloodstream infection.
Methods
• This prospective, randomized, controlled experimental study was undertaken in a university hospital’s pediatric intensive care unit (PICU) between December 2012, and January 2014.
• The trial was approved by the Ethics Committee.
Methods
• In total, 100 patients were enrolled into the study;
• 50 patients with chlorhexidine impregnated dressings (chlorhexidine group), and
• 50 patients with standard dressings (standard group).
Methods
Inclusion criteria;• Patient age of between 1 mounth-18year old,• Provided the treating physician felt the
inserted catheter would be present for a minimum of 72h.,
• CVCs inserted in PICU• Don’t use neuromuscular-blocking drugs• Have volunteered to participate in the study.
Methods
• Standard group;• The dressings of the standard group were changed
in accordance with standard clinical care. • Each patient’s skin was disinfected with a 10%
povidone-iodine solution 3 min and allowed to dry.
Methods
• Chlorhexidine group;• Catheter care Each patient’s skin was disinfected
with a 10% povidone-iodine solution 3min and allowed to dry.
• The chlorhexidine group’s dressings were changed every seven days.
Methods
• Both group;– Installing or removing a central venous catheter
care guide use – The catheter was inserted to comply with aseptic
technique. – After inserting catheter whilethe patient's daily
body care was taken to wet the pad.– Daily follow-up form was performed.
Methods
• Catheter site was observed on a daily basis.
• Catheter blood cultures before retiring, the
catheter is pulled and sent to a laboratory
breeding status of peripheral blood cultures
were evaluated.
Defination Catheter tip Central Catheter
hemoculture Peripheral catheter blood cultures
Result
No growth No growth or the same patogen with peripheral blood culture
No growth or the same patogen with central catheter blood culture
Sterile catheter
Reproduction(<15 cfu)
No growth or different patogen with catheter tip
No growth Contamination
Reproduction (≥ 15 cfu)
different patogen with catheter tip
different patogen with catheter tip
Colonization
Reproduction ReproductionHe same patogen with catheter tip
No growth Catheter-related bloodstream infection
Signs of inflammation over the catheter entry semiquantitative culture of the catheter tip with 15 cfu local catheter infection in case of reproductive factors (LK)
Results
100 patient
50 standard group 50 chlorhexidine group
Randomization-Patients;- 53 % 1 mounth-1 year old,-60 % male, -32 % respiratory system diseases-56% were found to have additional disease
Results
Central Venous Catheter colonization
4 (%8) standard group 1 (%2) chlorhexidine group
(p>0, 05)
Results
Local catheter infection
5 (%10) standard group 4 (%8) chlorhexidine group
(p>0, 05)
Results
Catheter-related bloodstream infection
5 (%10) standard group 1 (%2) chlorhexidine group
(p>0, 05)
Results
Catheter closure product
The duration of intensive care Duration of stay on mechanical ventilation The duration of the catheter
(p>0, 05)
CONCLUSIONS AND RECOMMENDATIONS
• 2% chlorhexidine impregnated dressings reduce the rates of CVC bloodstream infections and colonization in the pediatric intensive care unit.
• Although these results were not statistically significant, They are clinically important.
• It s recommended that 2% chlorhexidine impregnated dressings can used in PICU.
THANK YOU