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http://dx.doi.org/10.4040/jkan.19215

The Incidences of Catheter Colonization and Central Line-Associated Bloodstream Infection According to Tegaderm vs. Chlorhexidine Gluconate (CHG)-Tegaderm Dressing  

Kim, Eunji (Office of Infection Control, Gyeonggi Provincial Medical Center Ansung Hospital)
Lee, Haejung (College of Nursing, Pusan National University)
Publication Information
Journal of Korean Academy of Nursing / v.50, no.4, 2020 , pp. 541-553 More about this Journal
Abstract
Purpose: In spite of the recent application of a general infection control method, central line-associated infections is still relatively high in Korea. Central line bundle with Chlorhexidine gluconate (CHG) tegaderm dressing was reported to be effective in reducing catheter colonization and central line-associated bloodstream infections (CLABSI). Therefore, this study aimed to examine the incidences of catheter colonization occurrence and CLABSI while using Tegaderm vs. CHG Tegaderm dressings. Methods: We used a descriptive design. 400 patients who had central venous catheters were selected from four hospitals in the Korean National Healthcare-associated Infections Surveillance System. Of all subjects, 200 used Tegaderm™ (Tegaderm group), and the remaining 200 used CHG Tegaderm (CHG Tegaderm group) dressing at the catheter insertion site. Data were analyzed using the χ2 test or Fisher's exact test, t-test, and logistic regression analysis using SPSS WIN 21.0. Results: In the Tegaderm and CHG Tegaderm groups, CLABSI incidences were 5.89 and 1.79 per 1,000 catheter-days, catheter colonization incidences were 3.93 and 1.43 per 1,000 catheter-days, and central line bundle compliance rates were 26.0% and 49.0%, respectively. Catheter colonization risk factors were 'reinsertion after failure' and 'Tegaderm dressing' at the central line insertion site. CLABSI risk factors were 'incomplete performance of 7 central line bundle items' and 'Tegaderm dressing' at the central line insertion site. Conclusion: A further prospective study is needed to examine the effects of central line bundle with CHG Tegaderm dressing, avoiding central line reinsertion after failure, and improving the bundle compliance in reducing catheter colonization and CLABSI.
Keywords
Catheter-Related Infections; Central Venous Catheter; Chlorhexidine;
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1 Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care-associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections. Annals of Internal Medicine. 2002;137(10):791-797. https://doi.org/10.7326/0003-4819-137-10-200211190-00007   DOI
2 Kim EC. Current status of healthcare-associated infections in Korea. Hanyang Medical Reviews. 2011;31(3):135-140. https://doi.org/10.7599/hmr.2011.31.3.135   DOI
3 Gershengorn HB, Garland A, Kramer A, Scales DC, Rubenfeld G, Wunsch H. Variation of arterial and central venous catheter use in United States intensive care units. Anesthesiology. 2014;120(3):650-664.   DOI
4 Cho EE, Bevilacqua E, Brewer J, Hassett J, Guo WA. Variation in the practice of central venous catheter and chest tube insertions among surgery residents. Journal of Emergencies, Trauma, and Shock. 2018;11(1):47-52. https://doi.org/10.4103/JETS.JETS_124_15   DOI
5 Brasher C, Malbezin S. Central venous catheters in small infants. Anesthesiology. 2018;128(1):4-5. https://doi.org/10.1097/ALN.0000000000001961   DOI
6 Wei L, Li Y, Li X, Bian L, Wen Z, Li M. Chlorhexidine-impregnated dressing for the prophylaxis of central venous catheter-related complications: A systematic review and meta-analysis. BMC Infectious Diseases. 2019;19(1):429. https://doi.org/10.1186/s12879-019-4029-9   DOI
7 Park KH. Diagnosis and management of central venous catheter-related infections. The Korean Journal of Medicine. 2014;86(3):282-294. https://doi.org/10.3904/kjm.2014.86.3.282   DOI
8 Theodoro D, Olsen MA, Warren DK, McMullen KM, Asaro P, Henderson A, et al. Emergency department central line-associated bloodstream infections (CLABSI) incidence in the era of prevention practices. Academic Emergency Medicine. 2015;22(9):1048-1055. https://doi.org/10.1111/acem.12744   DOI
9 Lee KH, Cho NH, Jeong SJ, Kim MN, Han SH, Song YG. Effect of central line bundle compliance on central line-associated bloodstream infections. Yonsei Medical Journal. 2018;59(3):376-382. https://doi.org/10.3349/ymj.2018.59.3.376   DOI
10 Tomar S, Lodha R, Das B, Sood S, Kapil A. Risk factors for central line associated bloodstream infections. Indian Pediatrics. 2016;53(9):790-792. https://doi.org/10.1007/s13312-016-0932-y   DOI
11 Rosado V, Romanelli RM, Camargos PA. Risk factors and preventive measures for catheter-related bloodstream infections. Jornal de Pediatria. 2011;87(6):469-477. https://doi.org/10.2223/JPED.2134   DOI
12 Centers for Disease Control and Prevention (CDC). Updated recommendations on the use of chlorhexidine-impregnated dressings for prevention of intravascular catheter-related infections 2017 [Internet]. Atlanta: Centers for Disease Control and Prevention (CDC); c2017 [cited 2018 Oct 2]. Available from: https://www.cdc.gov/infectioncontrol/guidelines/bsi/c-i-dressings/index.html
13 Ridgway JP, Sun X, Tabak YP, Johannes RS, Robicsek A. Performance characteristics and associated outcomes for an automated surveillance tool for bloodstream infection. American Journal of Infection Control. 2016;44(5):567-571. https://doi.org/10.1016/j.ajic.2015.12.044   DOI
14 Aloush SM, Alsaraireh FA. Nurses' compliance with central line associated blood stream infection prevention guidelines. Saudi Medical Journal. 2018;39(3):273-279. https://doi.org/10.15537/smj.2018.3.21497   DOI
15 Hallam C, Jackson T, Rajgopal A, Russell B. Establishing catheter-related bloodstream infection surveillance to drive improvement. Journal of Infection Prevention. 2018;19(4):160-166. https://doi.org/10.1177/1757177418767759   DOI
16 Warren DK, Quadir WW, Hollenbeak CS, Elward AM, Cox MJ, Fraser VJ. Attributable cost of catheter-associated bloodstream infections among intensive care patients in a nonteaching hospital. Critical Care Medicine. 2006;34(8):2084-2089. https://doi.org/10.1097/01.CCM.0000227648.15804.2D   DOI
17 Nowak JE, Brilli RJ, Lake MR, Sparling KW, Butcher J, Schulte M, et al. Reducing catheter-associated bloodstream infections in the pediatric intensive care unit: Business case for quality improvement. Pediatric Critical Care Medicine. 2010;11(5):579-587. https://doi.org/10.1097/PCC.0b013e3181d90569   DOI
18 Pepin CS, Thom KA, Sorkin JD, Leekha S, Masnick M, Preas MA, et al. Risk factors for central-line-associated bloodstream infections: A focus on comorbid conditions. Infection Control & Hospital Epidemiology. 2015;36(4):479-481. https://doi.org/10.1017/ice.2014.81   DOI
19 Suljagic V, Cobeljic M, Jankovic S, Mirovic V, Markovic-Denic L, Romic P, et al. Nosocomial bloodstream infections in ICU and non-ICU patients. American Journal of Infection Control. 2005;33(6):333-340. https://doi.org/10.1016/j.ajic.2005.03.010   DOI
20 Kwak YG, Choi YH, Choi JY, Yoo HM, Lee SO, Kim HB, et al. Korean National Health care-Associated Infections Surveillance System, intensive care unit module report: Summary of data from July 2016 through June 2017. Korean Journal of Healthcare-Associated Infection Control and Prevention. 2018;23(2):25-38. https://doi.org/10.14192/kjhaicp.2018.23.2.25   DOI
21 Centers for Disease Control and Prevention (CDC). Data summary of HAIs in the US: Assessing progress 2006-2016 for CLABSI [Internet]. Atlanta: Centers for Disease Control and Prevention (CDC); c2017 [cited 2018 Oct 2]. Available from: https://www.cdc.gov/hai/data/archive/data-summary-assessing-progress.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhai%2Fsurveillance%2Fdata-reports%2Fdata-summary-assessing-progress.html
22 Cho HJ, Choi YH, Shin SS, Oh YJ, Hwang SC. Central venous catheter colonization and bloodstream infection: Influence of catheter insertion site and duration. Infection & Chemotherapy. 2005;37(2):65-70.
23 Lorente L, Henry C, Martin MM, Jimenez A, Mora ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Critical Care. 2005;9(6):R631-R635. https://doi.org/10.1186/cc3824   DOI
24 Kim KS, Kim S, Ji S, Lee J. Nosocomial bloodstream infection in intensive care unit in a general hospital. Korean Journal of Epidemiology. 2007;29(1):70-79.
25 Ishizuka M, Nagata H, Takagi K, Kubota K. Femoral venous catheterization is a major risk factor for central venous catheter-related bloodstream infection. Journal of Investigative Surgery. 2009;22(1):16-21. https://doi.org/10.1080/08941930802566698   DOI
26 Korean Society for Healthcare-associated Infection Control and Prevention (KOSHIC). KONIS manual 2018 [Internet]. Seoul: Korean Society for Healthcare-associated Infection Control and Prevention (KOSHIC); c2018 [cited 2018 Oct 2]. Available from: http://konis.cafe24.com/xe/index.php?mid=manual&-category=251&document_srl=653.
27 Choe PG, Shin HY, Shin MJ, Song KH, Kim ES, Jin HY, et al. P003: Current status of infection control practice for prevent of central venous catheter-associated bloodstream infection in Korea. Antimicrobial Resistance and Infection Control. 2013;2(Suppl 1):P3. https://doi.org/10.1186/2047-2994-2-S1-P3
28 Haga Y, Miyanari N, Takahashi T, Koike S, Kobayashi R, Mizusawa H, et al. Risk factors for catheter-related bloodstream infections in adult hospitalized patients - multicenter cohort study. Scandinavian Journal of Infectious Diseases. 2013;45(10):773-779. https://doi.org/10.3109/00365548.2013.807936   DOI
29 Buchman AL, Opilla M, Kwasny M, Diamantidis TG, Okamoto R. Risk factors for the development of catheter-related bloodstream infections in patients receiving home parenteral nutrition. Journal of Parenteral and Enteral Nutrition. 2014;38(6):744-749. https://doi.org/10.1177/0148607113491783   DOI
30 O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for prevention of intravascular catheter-related infection, 2011 [Internet]. Center for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP); c2015 [cited 2019 Aug 12]. Available from: https://www.cdc.gov/infectioncontrol/guidelines/BSI/index.html
31 Jenks M, Craig J, Green W, Hewitt N, Arber M, Sims A. Tegaderm CHG IV securement dressing for central venous and arterial catheter insertion sites: A NICE Medical Technology Guidance. Applied Health Economics and Health Policy. 2016;14(2):135-149. https://doi.org/10.1007/s40258-015-0202-5   DOI
32 Moon HJ, Cho YS, Kim HJ, Lim H, Lee MG, Yoo B, et al. Comparison of infection rates for central venous catheters administered in an intensive care unit versus an emergency department. Journal of the Korean Society of Emergency Medicine. 2011;22(6):669-675.
33 Ergul AB, Gokcek I, Ozcan A, Cetin S, Gultekin N, Torun YA. Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms. Pakistan Journal of Medical Sciences. 2018;34(2):347-351. https://doi.org/10.12669/pjms.342.14810   DOI
34 Timsit JF, Mimoz O, Mourvillier B, Souweine B, Garrouste-Orgeas M, Alfandari S, et al. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. American Journal of Respiratory and Critical Care Medicine. 2012;186(12):1272-1278. https://doi.org/10.1164/rccm.201206-1038OC   DOI
35 Lai NM, Lai NA, O'Riordan E, Chaiyakunapruk N, Taylor JE, Tan K. Skin antisepsis for reducing central venous catheter-related infections. Cochrane Database of Systematic Reviews. 2016;7(7):CD010140. https://doi.org/10.1002/14651858.CD010140.pub2
36 Dolci ME, Margatho AS, Silveira RC. Frequency of change of chlorhexidine-impregnated gel dressings for central venous catheters in critically ill patients. Escola Anna Nery. 2017;21(4):e20170026. https://doi.org/10.1590/2177-9465-ean-2017-0026
37 Eggimann P, Pagani JL, Dupuis-Lozeron E, Ms BE, Thevenin MJ, Joseph C, et al. Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years. Intensive Care Medicine. 2019;45(6):823-833. https://doi.org/10.1007/s00134-019-05617-x   DOI
38 Arvaniti K, Lathyris D, Clouva-Molyvdas P, Haidich AB, Mouloudi E, Synnefaki E, et al. Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: A multicenter, randomized, controlled study. Critical Care Medicine. 2012;40(2):420-429. https://doi.org/10.1097/CCM.0b013e31822f0d4b   DOI