The Effects of Chlorhexidine Dressing on Health Care-Associated Infection in Hospitalized Patients: A Meta-Analysis
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Abstract
Background: To assess the effects of chlorhexidine dressing on health care-associated infection in hospitalized patients.
Methods: We searched for English-language published randomized controlled trials (RCTs) in Cochrane Library, EMBASE and PubMed between January 1998 and January 2018. We used meta-analysis to calculate the risk ratios (RRs) and 95% confidence intervals (CIs) of the data, and using the I2 assessment to summarize the heterogeneity of RCTs and the funnel plot and Egger regression test to evaluate publication bias.
Results: A total of 13 RCTs were included in our meta-analysis, including 7555 patients and 11,931 catheters. The effects of chlorhexidine dressing on the incidence of catheter-related bloodstream infections (CRBSIs) were reported in 13 RCTs, and the incidence of CRBSIs were 1.3% (80/6160) in the chlorhexidine group and 2.5% (145/5771) in the control group. We used a forest plot to determine the risk ratio (RR) of chlorhexidine dressing on the incidence of CRBSIs, and our results showed that chlorhexidine dressing significantly reduced the incidence of CRBSIs (RR 0.55, 95% CI 0.39-0.77, P<0.001). Moreover, we also analyzed the effects of chlorhexidine dressing on the incidence of catheter colonization and catheter-related infections (CRIs), and our forest plot results showed that chlorhexidine dressing significantly reduced the incidence of catheter colonization (RR 0.52, 95% CI 0.40-0.67, P<0.001) and the incidence of CRIs (RR 0.43, 95% CI 0.28-0.66, P<0.001) in hospitalized patients.
Conclusion: The use of chlorhexidine dressings for hospitalized patients significantly reduce the incidence of CRBSIs, catheter colonization and CRIs.
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8. Montecalvo MA, McKenna D, Yarrish R, et al (2012). Chlorhexidine bathing to re-duce central venous catheter-associated bloodstream infection: impact and sus-tainability. Am J Med, 125(5):505-11.
9. Garland JS, Alex CP, Mueller CD, et al (2001). A randomized trial comparing povidone-iodine to a chlorhexidine glu-conate-impregnated dressing for preven-tion of central venous catheter infections in neonates. Pediatrics, 107(6):1431-6.
10. Timsit JF, Schwebel C, Bouadma L, et al (2009). Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA, 301(12):1231-41.
11. Ruschulte H, Franke M, Gastmeier P, et al (2009). Prevention of central venous catheter related infections with chlorhexi-dine gluconate impregnated wound dressings: a randomized controlled trial. Ann Hematol, 88(3):267-72.
12. Scheithauer S, Lewalter K, Schröder J, et al (2014). Reduction of central venous line-associated bloodstream infection rates by using a chlorhexidine-containing dress-ing. Infection, 42(1):155-9.
13. Düzkaya DS, Sahiner NC, Uysal G, et al (2016). Chlorhexidine-Impregnated Dressings and Prevention of Catheter-Associated Bloodstream Infections in a Pediatric Intensive Care Unit. Crit Care Nurse, 36(6):e1-e7.
14. Roberts B, Cheung D (1998). Biopatch--a new concept in antimicrobial dressings for invasive devices. Aust Crit Care, 11(1):16-9.
15. Arvaniti K, Lathyris D, Clouva-Molyvdas P, et al (2012). Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of asso-ciated colonization and infections in in-tensive care unit patients: a multicenter, randomized, controlled study. Crit Care Med, 40(2):420-9.
16. Biehl LM, Huth A, Panse J, et al (2016). A randomized trial on chlorhexidine dress-ings for the prevention of catheter-related bloodstream infections in neutropenic patients. Ann Oncol, 27(10):1916-22.
17. Webster J, Larsen E, Marsh N, et al (2017). Chlorhexidine gluconate or polyhexa-methylene biguanide disc dressing to re-duce the incidence of central-line-associated bloodstream infection: a feasi-bility randomized controlled trial (the CLABSI trial). J Hosp Infect, 96(3):223-228.
18. Gerçeker GÖ, Yardımcı F, Aydınok Y (2017). Randomized controlled trial of care bundles with chlorhexidine dressing and advanced dressings to prevent cathe-ter-related bloodstream infections in pe-diatric hematology-oncology patients. Eur J Oncol Nurs, 28:14-20.
19. Kim SY, Park JE, Lee YJ, et al (2013). Test-ing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validi-ty. J Clin Epidemiol, 66(4):408-14.
20. Stone J, Gurunathan U, Glass K, et al (2018). Stratification by quality induced se-lection bias in a meta-analysis of clinical trials. J Clin Epidemiol, (18)30744-3.
21. Fan H, Zhao Y, Sun M, et al (2017). Dex-medetomidine Based Sedation for Post-surgery Critically Ill Adults: A Meta-analysis of Randomized Controlled Tri-als. Iran J Public Health, 46(12):1611-1622.
22. Chambers ST, Sanders J, Patton WN, et al (2005). Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized con-trolled trial. J Hosp Infect, 61(1):53-61.
23. Levy I, Katz J, Solter E, et al (2005). Chlor-hexidine-impregnated dressing for pre-vention of colonization of central venous catheters in infants and children: a ran-domized controlled study. Pediatr Infect Dis J, 24(8):676-9.
24. Timsit JF, Mimoz O, Mourvillier B, et al (2012). Randomized controlled trial of chlorhexidine dressing and highly adhe-sive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med, 186(12):1272-8.
25. Vanhoozer G, Lovern Bs I, Masroor N, et al (2018). Chlorhexidine gluconate bath-ing: Patient perceptions, practices, and barriers at a tertiary care center. Am J Infect Control, (18)30826-5.
26. Alserehi H, Filippell M, Emerick M, et al (2018). Chlorhexidine gluconate bathing practices and skin concentrations in in-tensive care unit patients. Am J Infect Con-trol, 46(2):226-8.
27. Safdar N, Crnich CJ, Maki DG (2005). The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respir Care, 50(6):725-39.
28. Pages J, Hazera P, Mégarbane B, et al (2016). Comparison of alcoholic chlorhexidine and povidone-iodine cutaneous antisep-tics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study. In-tensive Care Med, 42(9):1418-26.
29. Swan JT, Ashton CM, Bui LN, et al (2016). Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial. Crit Care Med, 44(10):1822-32.
30. Boonyasiri A, Thaisiam P, Permpikul C, et al (2016). Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand. Infect Control Hosp Epidemiol, 37(3):245-53.
31. Safdar N, O'Horo JC, Ghufran A, et al (2014). Chlorhexidine-impregnated dress-ing for prevention of catheter-related bloodstream infection: a meta-analysis. Crit Care Med, 42(7):1703-13.
2. Hentrich M, Schalk E, Schmidt-Hieber M, et al (2014). Central venous catheter-related infections in hematology and oncology: 2012 updated guidelines on diagnosis, management and prevention by the In-fectious Diseases Working Party of the German Society of Hematology and Medical Oncology. Ann Oncol, 25(5):936-47.
3. O'Grady NP, Alexander M, Burns LA, et al (2011). Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control, 39(4 Suppl 1):S1-34.
4. Roethlisberger M, Moffa G, Fisch U, et al (2018). Effectiveness of a Chlorhexidine Dressing on Silver-coated External Ven-tricular Drain-associated Colonization and Infection: A Prospective Single-blinded Randomized Controlled Clinical Trial. Clin Infect Dis, 67(12):1868-77.
5. Centers for Disease Control and Prevention (CDC) (2011). Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep, 60(8):243-8.
6. Heimann SM, Biehl LM, Vehreschild JJ, et al (2018). Chlorhexidine-containing dress-ings in the prevention of central venous catheter-related bloodstream infections: A cost and resource utilization analysis. Am J Infect Control, 46(9):992-7.
7. Martínez-Reséndez MF, Garza-González E, Mendoza-Olazaran S, et al (2014). Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infec-tion rates in critically ill patients. Am J In-fect Control, 42(7):713-7.
8. Montecalvo MA, McKenna D, Yarrish R, et al (2012). Chlorhexidine bathing to re-duce central venous catheter-associated bloodstream infection: impact and sus-tainability. Am J Med, 125(5):505-11.
9. Garland JS, Alex CP, Mueller CD, et al (2001). A randomized trial comparing povidone-iodine to a chlorhexidine glu-conate-impregnated dressing for preven-tion of central venous catheter infections in neonates. Pediatrics, 107(6):1431-6.
10. Timsit JF, Schwebel C, Bouadma L, et al (2009). Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA, 301(12):1231-41.
11. Ruschulte H, Franke M, Gastmeier P, et al (2009). Prevention of central venous catheter related infections with chlorhexi-dine gluconate impregnated wound dressings: a randomized controlled trial. Ann Hematol, 88(3):267-72.
12. Scheithauer S, Lewalter K, Schröder J, et al (2014). Reduction of central venous line-associated bloodstream infection rates by using a chlorhexidine-containing dress-ing. Infection, 42(1):155-9.
13. Düzkaya DS, Sahiner NC, Uysal G, et al (2016). Chlorhexidine-Impregnated Dressings and Prevention of Catheter-Associated Bloodstream Infections in a Pediatric Intensive Care Unit. Crit Care Nurse, 36(6):e1-e7.
14. Roberts B, Cheung D (1998). Biopatch--a new concept in antimicrobial dressings for invasive devices. Aust Crit Care, 11(1):16-9.
15. Arvaniti K, Lathyris D, Clouva-Molyvdas P, et al (2012). Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of asso-ciated colonization and infections in in-tensive care unit patients: a multicenter, randomized, controlled study. Crit Care Med, 40(2):420-9.
16. Biehl LM, Huth A, Panse J, et al (2016). A randomized trial on chlorhexidine dress-ings for the prevention of catheter-related bloodstream infections in neutropenic patients. Ann Oncol, 27(10):1916-22.
17. Webster J, Larsen E, Marsh N, et al (2017). Chlorhexidine gluconate or polyhexa-methylene biguanide disc dressing to re-duce the incidence of central-line-associated bloodstream infection: a feasi-bility randomized controlled trial (the CLABSI trial). J Hosp Infect, 96(3):223-228.
18. Gerçeker GÖ, Yardımcı F, Aydınok Y (2017). Randomized controlled trial of care bundles with chlorhexidine dressing and advanced dressings to prevent cathe-ter-related bloodstream infections in pe-diatric hematology-oncology patients. Eur J Oncol Nurs, 28:14-20.
19. Kim SY, Park JE, Lee YJ, et al (2013). Test-ing a tool for assessing the risk of bias for nonrandomized studies showed moderate reliability and promising validi-ty. J Clin Epidemiol, 66(4):408-14.
20. Stone J, Gurunathan U, Glass K, et al (2018). Stratification by quality induced se-lection bias in a meta-analysis of clinical trials. J Clin Epidemiol, (18)30744-3.
21. Fan H, Zhao Y, Sun M, et al (2017). Dex-medetomidine Based Sedation for Post-surgery Critically Ill Adults: A Meta-analysis of Randomized Controlled Tri-als. Iran J Public Health, 46(12):1611-1622.
22. Chambers ST, Sanders J, Patton WN, et al (2005). Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized con-trolled trial. J Hosp Infect, 61(1):53-61.
23. Levy I, Katz J, Solter E, et al (2005). Chlor-hexidine-impregnated dressing for pre-vention of colonization of central venous catheters in infants and children: a ran-domized controlled study. Pediatr Infect Dis J, 24(8):676-9.
24. Timsit JF, Mimoz O, Mourvillier B, et al (2012). Randomized controlled trial of chlorhexidine dressing and highly adhe-sive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med, 186(12):1272-8.
25. Vanhoozer G, Lovern Bs I, Masroor N, et al (2018). Chlorhexidine gluconate bath-ing: Patient perceptions, practices, and barriers at a tertiary care center. Am J Infect Control, (18)30826-5.
26. Alserehi H, Filippell M, Emerick M, et al (2018). Chlorhexidine gluconate bathing practices and skin concentrations in in-tensive care unit patients. Am J Infect Con-trol, 46(2):226-8.
27. Safdar N, Crnich CJ, Maki DG (2005). The pathogenesis of ventilator-associated pneumonia: its relevance to developing effective strategies for prevention. Respir Care, 50(6):725-39.
28. Pages J, Hazera P, Mégarbane B, et al (2016). Comparison of alcoholic chlorhexidine and povidone-iodine cutaneous antisep-tics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study. In-tensive Care Med, 42(9):1418-26.
29. Swan JT, Ashton CM, Bui LN, et al (2016). Effect of Chlorhexidine Bathing Every Other Day on Prevention of Hospital-Acquired Infections in the Surgical ICU: A Single-Center, Randomized Controlled Trial. Crit Care Med, 44(10):1822-32.
30. Boonyasiri A, Thaisiam P, Permpikul C, et al (2016). Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand. Infect Control Hosp Epidemiol, 37(3):245-53.
31. Safdar N, O'Horo JC, Ghufran A, et al (2014). Chlorhexidine-impregnated dress-ing for prevention of catheter-related bloodstream infection: a meta-analysis. Crit Care Med, 42(7):1703-13.
| Files | ||
| Issue | Vol 48 No 5 (2019) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v48i5.1794 | |
| Keywords | ||
| Chlorhexidine dressing Catheter-related bloodstream infections Randomized controlled trials | ||
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How to Cite
1.
WANG H-X, XIE S-Y, WANG H, CHU H-K. The Effects of Chlorhexidine Dressing on Health Care-Associated Infection in Hospitalized Patients: A Meta-Analysis. Iran J Public Health. 2019;48(5):796-807.
