Sustained Reduction of Catheter Associated Bloodstream Infections with Enhancement of Catheter Bundle by Chlorhexidine Dressings

BACKGROUND  Prospective randomized controlled studies have demonstrated that addition of chlorhexidine (CHG) dressings reduce the rate of catheter (central venous and arterial) associated bloodstream infections (CABSI). However, studies confirming their impact in a real world setting are lacking. METHODS  We conducted a real world evidence study evaluating the impact of incrementally introducing chlorhexidine dressings (sponge or gel) in addition to an ongoing catheter bundle on the rates of CABSI, expressed as incidence density rates per 1000 catheter-days measured as part of a surveillance program. Poisson regression models were used to compare infections rates over time. Both dressings were used simultaneously during one of the five study periods. FINDINGS  From 2006 to 2014, 18 286 patients were admitted (91 292 ICU-days and 155 242 catheter-days). We recorded 111 CABSI. We observed a significant decrease of CABSI rates from 1.48 (95%CI: 1¬·09-2·01) without CHG-dressings to 0·69 (95%CI: 0·43-1·09) and 0·23 (95%CI: 0·11-0·48) episodes per 1000 catheter-days when CHG-sponge and CHG-gel dressings were used (p=0·0007; p<0·001). The rates were lower for CHG-gel compared to CHG-sponge dressings when comparing different study periods and when both dressings were used simultaneously. This difference did not reach statistical significance due to the low number of infections. INTERPRETATION  The addition of chlorhexidine dressings to all CVC and arterial lines to an ongoing catheter bundle resulted in a significantly sustained seven-year reduction of all catheter-associated bloodstream infections. This large real world evidence study further supports the current recommendations for the systematic use of CHG-dressings on all catheters of ICU patients. Funding: Partially supported by an unrestricted research grant from 3M. Declaration of Interest: PE and CJ served in the speaker bureau of 3M and of Ethicon, manufacturer of the disinfectant dressings used during the intervention. PE received an unrestricted research grant to support the analysis of the data. BE from 3M performed the statistical work. SFB from 3M provided writing assistance and language editing. Part of the data were provided to 3M and to the FDA in March 2017. The authors declared no other conflicts of interest. Ethical Approval: As the interventions were included in the measures targeted at improvement of the quality of care, with products with a patent for use in patients in Switzerland, the commission cantonale d’ethique de la recherche sur l’etre humain and the institutional review board approved the study and waived the need for informed consent.