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451 Chlorhexidine-Impregnated Dressing For Prevention Of Catheter-Related Bloodstream Infection: A Meta-Analysis

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Nasia Safdar, MD , University of Wisconsin Madison, Madison, WI
Aiman Ghufran, MD , University of Wisconsin Madison, Madison, WI
Allison Bearden, MD , University of Wisconsin Madison, Madison, WI
Maria Eugenia Didier, MD , University of Wisconsin Madison, Madison, WI

Background: Prevention of catheter-related bloodstream infection (CRBSI) is essential. Chlorhexidine-impregnated dressings have been proposed as an effective strategy for prevention of CRBSI. However, the magnitude of benefit is uncertain.

Objective: To assess the efficacy of a chlorhexidine-impregnated dressing for prevention of central venous catheter-related colonization and catheter-related bloodstream infection (CRBSI) using meta-analysis.  

Methods: Data Sources: Multiple computerized database searches supplemented by manual searches for relevant articles. Study Selection: Randomized, controlled trials evaluating efficacy of a chlorhexidine-impregnated dressing compared with conventional dressings for prevention of catheter colonization and CRBSI. Data Extraction: Data were extracted on patient population, inclusion and exclusion criteria, diagnostic criteria for colonization and bloodstream infection, incidence of CRBSI and colonization.

Data Synthesis: Data on incidence of CRBSI and colonization were abstracted as dichotomous variables. Pooled estimates of the relative risk (RR) and 95% confidence intervals (CI) were obtained using the DerSimonian and Laird random effects model and the Mantel-Haenzel fixed effects model. Heterogeneity was assessed using the Cochran Q statistic and I2. Subgroup analyses were used to explore heterogeneity.

Results: Seven randomized controlled trials met the inclusion criteria. Overall, 1.5% (51/3381) of patients developed CRBSI in the treatment group compared with 2.8% (96/3344) of patients in the comparator group. A chlorhexidine-impregnated dressing resulted in a reduced incidence of CRBSI (RR 0.57, 95% CI 0.36-0.91) using a random effects model. The incidence of catheter colonization was also reduced in the chlorhexidine-impregnated dressing group (0.52, 95% CI 0.40-0.67). The I2 test showed little heterogeneity.

Conclusions: Our analysis showed that a chlorhexidine-impregnated dressing is beneficial in preventing catheter colonization and more importantly, CRBSI. A chlorhexidine-impregnated dressing should be considered for the prevention of CRBSI.