Randomized Controlled Trial of Chlorhexidine Dressing and Highly Adhesive Dressing for Preventing Catheter-related Infections in Critically Ill Adults

Rationale: Most vascularcatheter-relatedinfections(CRIs)occurextraluminally in patients in the intensive care unit (ICU). Chlorhexidineimpregnated and strongly adherent dressings may decrease catheter colonization and CRI rates. Objectives: To determine if chlorhexidine-impregnated and strongly adherent dressings decrease catheter colonization and CRI rates. Methods:Ina2:1:1assessor-maskedrandomizedtrialinpatientswith vascular catheters inserted for an expected duration of 48 hours or morein12FrenchICUs,wecomparedchlorhexidinedressings,highly adhesive dressings, and standard dressings from May 2010 to July 2011. Coprimary endpoints were major CRI with or without catheterrelated bloodstream infection (CR-BSI) with chlorhexidine versus nonchlorhexidinedressingsandcathetercolonizationratewithhighly adhesivenonchlorhexidineversusstandardnonchlorhexidinedressings.Catheter-colonization,CR-BSIs,andskinreactionsweresecondary endpoints. Measurements and Main Results: A total of 1,879 patients (4,163 cathetersand34,339 catheter-days) wereevaluated. With chlorhexidine dressings,themajor-CRIratewas67%lower(0.7per1,000vs.2.1per 1,000catheter-days;hazardratio[HR],0.328;95%confidenceinterval [CI],0.174–0.619;P¼0.0006)andtheCR-BSIrate60%lower(0.5per 1,000 vs. 1.3 per 1,000 catheter-days; HR, 0.402; 95% CI, 0.186– 0.868; P ¼ 0.02) than with nonchlorhexidine dressings; decreases were noted in catheter colonization and skin colonization rates at catheter removal. The contact dermatitis rate was 1.1% with and 0.29% without chlorhexidine. Highly adhesive dressings decreased the detachment rate to 64.3% versus 71.9% (P , 0.0001) and the number of dressings per catheter to two (one to four) versus three (onetofive)(P,0.0001)butincreasedskincolonization(P,0.0001) andcathetercolonization(HR,1.650;95%CI,1.21–2.26;P¼0.0016)