Health care-associated infections (HCAIs) are infections that appear on the first 48 hours or more after hospital admission, or within 30 days after receiving health care within the institution.
Health-care associated infection includes Central line-associated blood stream infections (CLABSIs). According to CDC Centers for Disease control and prevention (CDC) 2009 it is reported to have 12%-25% of mortality rate and extended hospital stays., and in 2021, the Centers for Disease Control and Prevention (CDC) also reported a total of 30 389 CLABSIs occurring in various inpatient locations.
Proper skin antisepsis is essential in preventing CLABSI. If the skin is not cleaned properly, pathogens can travel along the external surface of the catheter from the point where it enters the skin. As a result, skin pathogens are often a major cause of CLABSI, particularly within the first week following central line catheter insertion.
BIOPATCH- polyurethane foam allowing quick absorption of fluid decreasing the likelihood of skin maceration, designed to deliver chlorhexidine gluconate a full 360 degree around the catheter insertion site providing optimized coverage and protection.
CHG - an all-in-one antimicrobial and transparent CHG gel pad securement dressing. Provides immediate and continuous antimicrobial protection with an integrated chlorhexidine gluconate (CHG) gel pad. CHG gel pad provides antimicrobial activity suppressing skin flora regrowth for up to 7 days and allows delivery of CHG under the catheter
PICO
P: Hospitalized Adult Patient with central line.
I: Use chlorhexidine impregnated dressing (CHG).
C: Use of Biopatch with Tegaderm dressing.
O: Minimize the incidence or occurrence of Central Line-Associated Bloodstream Infections.
QUESTION: In hospitalized Adult Patient with central catheter in place (P) Does the use chlorhexidine impregnated dressing (CHG) (I) compared to use of Biopatch with Tegaderm dressing (C.) minimize the incidence or occurrence of Central Line-Associated Bloodstream Infections? (O).
In the study entitled Prevention of Central Line Associated Bloodstream Infections: Aseptic Insertion and Site Selection by Centers for Disease control and prevention. CLEAN trial published in 2015 Uses Randomized controlled trial as a study design. Sample size the enrolled 2,546 patients in 11 intensive care units in France. Results reveals that Alcohol-containing chlorhexidine-gluconate is the most effective skin antisepsis at reducing CLABSI compared to povidone iodine. A systematic review significantly shows a reduced risk of CLABSIs Risk Ratio 0.51 (95%CI 0.27-0.97%). But for patients allergic to CHG or patient under two months of age, povidone iodine is a suitable alternative. This concludes that Chlorhexidine-based alcohol solutions represent standard for skin antisepsis during central venous catheter placement and Povidone iodine should be reserved for patients who are allergic to chlorhexidine or patient under two months of age.
This study helps and serve as a guide for healthcare professional in ensuring control and prevention of Health care-associated infections specifically Central Line-Associated Bloodstream Infections among critically ill patient with central catheter in place.
References
(n.d.). Centers for Disease Control and Prevention | CDC. https://www.cdc.gov/infection-control/media/pdfs/Strive-CLABSI103-508.pdf
In the study entitled Comparative Effectiveness of 2 Chlorhexidine Gluconate-Containing Dressings in Reducing Central Line-Associated Bloodstream Infections, Hospital Stay, and Costs. By Yuefeng Hou et.al
A retrospective analysis was conducted using the Premier Healthcare Database of hospitalized patients 53 149 with central venous catheters and a comparative study between 2 different types of CHG receiving either a transparent CHG gel dressing -14 488 or an opaque CHG sponge dressing 38 661 between January 1, 2019 and September 30, 2020. Result reveals
CHG gel dressings were associated with a 41% decrease in CLABSI rates compared to CHG sponge dressings, a 0.4-day shorter length of stay and a cost saving of $3576 per hospital stay was observed with CHG gel dressing use. This concludes that use of CHG gel dressings substantially lower CLABSI rates and clinical expenses compared to opaque CHG sponge dressings for hospitalized patients, this also promote economic advantage with respect to clinical cost.
The present study also emphasizes that CHG sponge dressings were gradually replaced with CHG gel dressings in reducing occurrence of Central Line-Associated Bloodstream Infections, and I personally witnessed this change of replacement from Biopatch dressing to CHG dressing in patient with central line within our institution.
Limitation of the study: Only 2 different types of CHG dressings where compared.
Reference:
Comparative effectiveness of 2 chlorhexidine gluconate-containing dressings in reducing central line-associated bloodstream infections, hospital stay, and costs. (n.d.). PMC Home. https://pmc.ncbi.nlm.nih.gov/articles/PMC10693226/?fbclid=IwZXh0bgNhZW0CMTEAAR0mIlroMCepj09nBMNHoBvgW4ZjUi_bzqq5tGYTOEGQWr6ZYji6QwNQnQo_aem_ShgqEQms9pPfISdp_YZp1Q
In summary, The two nursing journals related to use of chlorhexidine impregnated dressing (CHG) reported similar findings which also support by another study study entitled: “Fitness of use of Biopatch and Tegaderm CHG for protecting central venous catheters and arterial lines in critically ill patients “ by P Eggimann using comparative study that aim compare fitness use of biopatch and CHG Tegaderm to central line catheter site in a sample size 2000 admissions and 11’000 patients-days yearly in mixed ICU of 5 units of 7 beds. Result reveals overall satisfaction significantly increases after 14 months of Tegaderm significant improvement of fitness of use recommend replacement the Biopatch by the Tegaderm-CHG in the dressing of all central venous catheters and arterial lines for all ICU patients. Another study entitled Effectiveness of chlorhexidine dressings to prevent catheter-related bloodstream infections. Does one size fit all? A systematic literature review and meta-analysis by: Puig-Asensio M using systematic review and meta-analysis in evaluating effectiveness of chlorhexidine (CHG) dressings to prevent catheter-related bloodstream infections were studied in 18 randomized controlled trials reveals that CHG dressings significantly reduced CRBSIs by 95 %.
This suggests that usage of CHG gel dressings as a routine practice for patients with central venous catheters can help minimize the risk of central line-associated bloodstream infections that help healthcare provider in providing good quality care among the patients.
Reference :
Fitness of use of Biopatch® and TegadermTM CHG for protecting central venous catheters and arterial lines in critically ill patients - PMC. (n.d.). PMC Home. https://pmc.ncbi.nlm.nih.gov/articles/PMC4474738/
Effectiveness of chlorhexidine dressings to prevent catheter-related bloodstream infections. Does one size fit all? A systematic literature review and meta-analysis. (n.d.). PubMed.
Reflection of Applicability: This study encourages the healthcare provider in considering usage CHG gel dressings as a standard practice for patients with central venous catheter to reduce the risk central line-associated bloodstream infections and improve patient outcomes.
As an infection liaison officer in my institution and as a coronary care unit nurse that is responsible in taking good care of critically ill patient specifically patient with central catheter in place, This study serve as a guide for me to become an advocate in promoting interdisciplinary collaboration that to encourage my co-workers, superior and policy maker in our institution to implement the evidence-base intervention related to central line bundles of care, and to develop or modify existing guidelines or checklist with respect to the current trends, training of nursing staff through return demonstration and seminars in relation to strict adherence to the use of CHG dressing and aseptic technique when handling central venous catheter in preventing occurrence of central Line-Associated Bloodstream Infections among hospitalized patient.
Health-care associated infection includes Central line-associated blood stream infections (CLABSIs). According to CDC Centers for Disease control and prevention (CDC) 2009 it is reported to have 12%-25% of mortality rate and extended hospital stays., and in 2021, the Centers for Disease Control and Prevention (CDC) also reported a total of 30 389 CLABSIs occurring in various inpatient locations.
Proper skin antisepsis is essential in preventing CLABSI. If the skin is not cleaned properly, pathogens can travel along the external surface of the catheter from the point where it enters the skin. As a result, skin pathogens are often a major cause of CLABSI, particularly within the first week following central line catheter insertion.
BIOPATCH- polyurethane foam allowing quick absorption of fluid decreasing the likelihood of skin maceration, designed to deliver chlorhexidine gluconate a full 360 degree around the catheter insertion site providing optimized coverage and protection.
CHG - an all-in-one antimicrobial and transparent CHG gel pad securement dressing. Provides immediate and continuous antimicrobial protection with an integrated chlorhexidine gluconate (CHG) gel pad. CHG gel pad provides antimicrobial activity suppressing skin flora regrowth for up to 7 days and allows delivery of CHG under the catheter
PICO
P: Hospitalized Adult Patient with central line.
I: Use chlorhexidine impregnated dressing (CHG).
C: Use of Biopatch with Tegaderm dressing.
O: Minimize the incidence or occurrence of Central Line-Associated Bloodstream Infections.
QUESTION: In hospitalized Adult Patient with central catheter in place (P) Does the use chlorhexidine impregnated dressing (CHG) (I) compared to use of Biopatch with Tegaderm dressing (C.) minimize the incidence or occurrence of Central Line-Associated Bloodstream Infections? (O).
In the study entitled Prevention of Central Line Associated Bloodstream Infections: Aseptic Insertion and Site Selection by Centers for Disease control and prevention. CLEAN trial published in 2015 Uses Randomized controlled trial as a study design. Sample size the enrolled 2,546 patients in 11 intensive care units in France. Results reveals that Alcohol-containing chlorhexidine-gluconate is the most effective skin antisepsis at reducing CLABSI compared to povidone iodine. A systematic review significantly shows a reduced risk of CLABSIs Risk Ratio 0.51 (95%CI 0.27-0.97%). But for patients allergic to CHG or patient under two months of age, povidone iodine is a suitable alternative. This concludes that Chlorhexidine-based alcohol solutions represent standard for skin antisepsis during central venous catheter placement and Povidone iodine should be reserved for patients who are allergic to chlorhexidine or patient under two months of age.
This study helps and serve as a guide for healthcare professional in ensuring control and prevention of Health care-associated infections specifically Central Line-Associated Bloodstream Infections among critically ill patient with central catheter in place.
References
(n.d.). Centers for Disease Control and Prevention | CDC. https://www.cdc.gov/infection-control/media/pdfs/Strive-CLABSI103-508.pdf
In the study entitled Comparative Effectiveness of 2 Chlorhexidine Gluconate-Containing Dressings in Reducing Central Line-Associated Bloodstream Infections, Hospital Stay, and Costs. By Yuefeng Hou et.al
A retrospective analysis was conducted using the Premier Healthcare Database of hospitalized patients 53 149 with central venous catheters and a comparative study between 2 different types of CHG receiving either a transparent CHG gel dressing -14 488 or an opaque CHG sponge dressing 38 661 between January 1, 2019 and September 30, 2020. Result reveals
CHG gel dressings were associated with a 41% decrease in CLABSI rates compared to CHG sponge dressings, a 0.4-day shorter length of stay and a cost saving of $3576 per hospital stay was observed with CHG gel dressing use. This concludes that use of CHG gel dressings substantially lower CLABSI rates and clinical expenses compared to opaque CHG sponge dressings for hospitalized patients, this also promote economic advantage with respect to clinical cost.
The present study also emphasizes that CHG sponge dressings were gradually replaced with CHG gel dressings in reducing occurrence of Central Line-Associated Bloodstream Infections, and I personally witnessed this change of replacement from Biopatch dressing to CHG dressing in patient with central line within our institution.
Limitation of the study: Only 2 different types of CHG dressings where compared.
Reference:
Comparative effectiveness of 2 chlorhexidine gluconate-containing dressings in reducing central line-associated bloodstream infections, hospital stay, and costs. (n.d.). PMC Home. https://pmc.ncbi.nlm.nih.gov/articles/PMC10693226/?fbclid=IwZXh0bgNhZW0CMTEAAR0mIlroMCepj09nBMNHoBvgW4ZjUi_bzqq5tGYTOEGQWr6ZYji6QwNQnQo_aem_ShgqEQms9pPfISdp_YZp1Q
In summary, The two nursing journals related to use of chlorhexidine impregnated dressing (CHG) reported similar findings which also support by another study study entitled: “Fitness of use of Biopatch and Tegaderm CHG for protecting central venous catheters and arterial lines in critically ill patients “ by P Eggimann using comparative study that aim compare fitness use of biopatch and CHG Tegaderm to central line catheter site in a sample size 2000 admissions and 11’000 patients-days yearly in mixed ICU of 5 units of 7 beds. Result reveals overall satisfaction significantly increases after 14 months of Tegaderm significant improvement of fitness of use recommend replacement the Biopatch by the Tegaderm-CHG in the dressing of all central venous catheters and arterial lines for all ICU patients. Another study entitled Effectiveness of chlorhexidine dressings to prevent catheter-related bloodstream infections. Does one size fit all? A systematic literature review and meta-analysis by: Puig-Asensio M using systematic review and meta-analysis in evaluating effectiveness of chlorhexidine (CHG) dressings to prevent catheter-related bloodstream infections were studied in 18 randomized controlled trials reveals that CHG dressings significantly reduced CRBSIs by 95 %.
This suggests that usage of CHG gel dressings as a routine practice for patients with central venous catheters can help minimize the risk of central line-associated bloodstream infections that help healthcare provider in providing good quality care among the patients.
Reference :
Fitness of use of Biopatch® and TegadermTM CHG for protecting central venous catheters and arterial lines in critically ill patients - PMC. (n.d.). PMC Home. https://pmc.ncbi.nlm.nih.gov/articles/PMC4474738/
Effectiveness of chlorhexidine dressings to prevent catheter-related bloodstream infections. Does one size fit all? A systematic literature review and meta-analysis. (n.d.). PubMed.
Reflection of Applicability: This study encourages the healthcare provider in considering usage CHG gel dressings as a standard practice for patients with central venous catheter to reduce the risk central line-associated bloodstream infections and improve patient outcomes.
As an infection liaison officer in my institution and as a coronary care unit nurse that is responsible in taking good care of critically ill patient specifically patient with central catheter in place, This study serve as a guide for me to become an advocate in promoting interdisciplinary collaboration that to encourage my co-workers, superior and policy maker in our institution to implement the evidence-base intervention related to central line bundles of care, and to develop or modify existing guidelines or checklist with respect to the current trends, training of nursing staff through return demonstration and seminars in relation to strict adherence to the use of CHG dressing and aseptic technique when handling central venous catheter in preventing occurrence of central Line-Associated Bloodstream Infections among hospitalized patient.