WOUND DRESSING

Wound Dressing Changes for Prevention of Catheter-Related Infections

Table of Contents

INTRODUCTION2

VALIDITY3

Design of the experiment3

Study Patients3

EVALUATION CRITERIA5

RESULTS5

Statistical Analysis5

Patients care7

ADVERSE EVENTS10

Wound Dressing Changes10

Comments on the Results11

STUDY LIMITATIONS13

CONCLUSION13

REFERENCES14

Wound Dressing Changes for Prevention of Catheter-Related Infections

Introduction

Most organisms responsible for wound dressing related bloodstream infections originate from the insertion sites of short-term wound dressings. Therefore, decreasing bacterial colonization of the skin at the insertion site may decrease the risk of bloodstream infection. New materials under development to decrease colonization include a chlorhexidine gluconate-impregnated sponge (CHGIS) (BioPatch; Ethicon Inc, Somerville, NJ) to be placed over the wound insertion site. A meta-analysis of small or unpublished studies of the CHGIS has suggested a significant decrease in catheter colonization and a nonsignificant decrease in CVC-related bloodstream infections, indicating a need for a large randomized controlled trial. The aim of this study was to evaluate the respective effects of using CHGIS wound dressings and increasing the time between dressing changes in adult ICU patients. We hypothesized that wound dressings would decrease the rate of major catheter-related infections (CRIs), defined as catheter-related sepsis with or without bloodstream infection, and that a longer time between dressing changes would not increase the rate of major CRIs. (Guyatt 1993)

Validity

The assignment of patients to treatment were completely randomized using factorial design. Studies in recipients of bone marrow transplants found no evidence that increasing the time between wound dressing changes induced adverse effects. No data exist to determine whether the interval between wound dressing changes can be safely extended in other populations.

Design of the experiment

It was a multicenter, 2 x 2 factorial, randomized controlled trial to compare CHGIS vs standard wound dressings and to compare a strategy of changing unsoiled adherent wound dressings every 7 days vs the standard practice of every 3 days. The study was not blinded for the investigators or ICU staff but was blinded for the microbiologists processing the skin and catheter cultures and for the assessors.

Study Patients

All the patients who entered the trial were properly accounted for and attributed at its conclusion. From December 20, 2006, to May 20, 2008, we recruited patients in 7 ICUs (2 medical, 2 surgical, 3 medical-surgical) in 3 university and 2 general hospitals in France. Patients older than 18 years expected to require an arterial catheter, central-vein catheter, or both inserted for 48 hours or longer were eligible. Patients with a history of allergy to chlorhexidine or to transparent wound dressings were excluded. (Eddy 1982)

Patients, their clinicians and study personnel were blind to all the treatments. All arterial catheters and wounds in a given patient were managed in the same way. Pulmonary arterial, hemodialysis, and peripherally inserted wounds were not included. Both the groups were similar at the time fo trial. All study centers followed French recommendations for catheter insertion and care, which are similar to recommendations from the Centers for Disease Control and Prevention. Briefly, the insertion sites were the radial artery and subclavian vein whenever possible, unless using these sites carried an increased risk of noninfectious ...