Determining the Effectiveness of Preventive Measures in Reducing Intravenous Injection and Catheter-Related Infections: A Meta-Analysis
-
Huan Zhang
,
Jiahuan He
,
Feifei Ke
,
Miao Li
,
Wenjia Yao
Abstract
Background: We aimed to evaluate the efficacy of preventative strategies targeted at lowering these injections.
Methods: A comprehensive assessment of electronic databases (PubMed, Web of Science, and Cochrane Library) was carried out to discover relevant papers published from 2013-2024. Inclusion criteria were randomised controlled trials, quasi-experimental studies, and observational research on therapy for intravenous injection and catheter-related infections. The primary outcome examined was the incidence or prevalence of infections caused by intravenous injections. According to preliminary data from 31 studies, preventive interventions dramatically reduce the incidence of intravenous injection and catheter-related infections. Subgroup analyses indicate effectiveness differences depending on intervention type and patient variables.
Results: Chlorhexidine-based therapies can lower infection risk by 29% (Risk Ratio: 0.71), but taurolidine provides a statistically significant 53% benefit (RR = 0.47). The total risk ratio varies from 0.71 to 0.84, indicating a 29% reduction in infection rates in nations having Needlestick Safety and Prevention Acts. In contrast, the absence of such regulation may result in a 6% to 8% rise in infection rates (RR = 0.96).
Conclusion: Preventative interventions, notably chlorhexidine and taurolidine, can considerably reduce the risk of intravenous injection and catheter-related infections. Chlorhexidine may lower the risk of infection by 29%, whereas taurolidine reduces it by 53%. Nations with Needlestick Safety and Prevention Acts may expect a one-third reduction in infection rates. Conversely, the absence of such laws may result in a significant rise in infection rates.
1. Rivera AM, Strauss KW, van Zundert A, Mortier E (2005). The history of periph-eral intravenous catheters: how little plastic tubes revolutionized medicine. Acta Anaesthesiol Belg, 56 (3): 271-82.
2. Ye R, Zhao L, Wang C, Wu X, Yan H (2014). Clinical characteristics of septic pulmonary embolism in adults: a sys-tematic review. Respir Med, 108 (1): 1-8.
3. Park DR, Sherbin VL, Goodman MS, et al (2001). The etiology of community‐acquired pneumonia at an urban public hospital: influence of human immuno-deficiency virus infection and initial se-verity of illness. J Infect Dis, 184 (3): 268-77.
4. Tognetti L, Martinelli C, Berti S, et al (2012). Bacterial skin and soft tissue infections: review of the epidemiology, microbiol-ogy, aetiopathogenesis and treatment: a collaboration between dermatologists and infectivologists. J Eur Acad Dermatol Venereol, 26 (8): 931-41.
5. Dunleavy K, Hope V, Roy K, Taylor A (2019). The experiences of people who inject drugs of skin and soft tissue infec-tions and harm reduction: A qualitative study. Int J Drug Policy, 65: 65-72.
6. World Health Organization (2011). Report on the Burden of Endemic Health Care-associated Infection Worldwide. Gene-va: World Health Organization.
7. Lee GH, Moon H, Kim H, et al (2020). Mul-tifunctional materials for implantable and wearable photonic healthcare de-vices. Nat Rev Mater, 5 (2): 149-65.
8. Golestaneh L, Mokrzycki MH (2018). Pre-vention of hemodialysis catheter infec-tions: Ointments, dressings, locks, and catheter hub devices. Hemodial Int, 22 (S2): S75-S82.
9. Piątkowska E, Paleczny J, Dydak K, Letachowicz K (2021). Antimicrobial ac-tivity of hemodialysis catheter lock solu-tions in relation to other compounds with antiseptic properties. PLoS One, 16 (10): e0258148.
10. Wiegers C, Van de Burgwal LH, Larsen OF (2022). Probiotics for the management of infectious diseases: reviewing the state of the art. Front Microbiol, 13: 877142.
11. Leung L (2015). Validity, reliability, and generalizability in qualitative research. J Family Med Prim Care, 4 (3): 324-7.
12. Page MJ, McKenzie JE, Bossuyt PM, et al (2021). The PRISMA 2020 statement: an updated guideline for reporting system-atic reviews. BMJ, 372: n71.
13. Biehl LM, Huth A, Panse J, et al. (2016). A randomized trial on chlorhexidine dressings for the prevention of catheter-related bloodstream infections in neu-tropenic patients. Ann Oncol, 27 (10): 1916-22.
14. Chan RJ, Northfield S, Larsen E, et al. (2017). Central venous access device se-curement and dressing effectiveness for peripherally inserted central catheters in adult acute hospital patients (CAS-CADE): a pilot randomised controlled trial. Trials, 18: 458.
15. Düzkaya DS, Sahiner NC, Uysal G, Yakut T, Çıtak A (2016). Chlorhexidine-impregnated dressings and prevention of catheter-associated bloodstream in-fections in a pediatric intensive care unit. Crit Care Nurse, 36 (1): e1-e7.
16. Ergul AB, Gokcek I, Ozcan A, et al (2018). Use of a chlorhexidine-impregnated dressing reduced catheter-related blood-stream infections caused by gram-positive microorganisms. Pak J Med Sci, 34 (2): 347-51.
17. Gerçeker GÖ, Yardımcı F, Aydınok Y (2017). Randomized controlled trial of care bundles with chlorhexidine dress-ing and advanced dressings to prevent catheter-related bloodstream infections in pediatric hematology-oncology pa-tients. Eur J Oncol Nurs, 28: 14-20.
18. Margatho AS, Ciol MA, Hoffman JM, et al. (2019). Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critical-ly ill adult patients: a pilot randomised controlled trial. Aust Crit Care, 32 (6): 471-8.
19. Pedrolo E, Danski MT, Vayego SA (2014). Chlorhexidine and gauze and tape dressings for central venous catheters: a randomized clinical trial. Rev Lat Am Enfermagem, 22 (5): 764-71.
20. Pivkina AI, Gusarov VG, Blot SI, et al. (2018). Effect of an acrylic terpolymer barrier film beneath transparent cathe-ter dressings on skin integrity, risk of dressing disruption, catheter colonisa-tion and infection. Intensive Crit Care Nurs, 46: 17-23.
21. Yu K, Lu M, Meng Y, Zhao Y, Li Z (2019). Chlorhexidine gluconate transparent dressing does not decrease central-line-associated bloodstream infection in crit-ically ill patients: a randomized con-trolled trial. Int J Nurs Pract, 25 (6): e12776.
22. Barnova I, Fragkos K, Morgan S, et al. (2015). Significant reduction in catheter-related bloodstream infections in high-risk adult patients on home PN or IV fluids after introduction of secondary prophylaxis with taurolidine-citrate line lock. Gut, 64 (Suppl 1): A496.
23. Buang SNH, Logarajah V, Lan NS, Liwanag MJ, Bixia A, Ong C (2017). Home paren-teral nutritional support in paediatric chronic intestinal failure -- a single Asian centre experience. Arch Dis Child, 102 (Suppl 2): A119.
24. Chong CY, Ong RYL, Seah VXF, et al. (2020). Taurolidine–citrate lock solution for the prevention of central line‐associated bloodstream infection in paediatric haematology–oncology and gastrointestinal failure patients with high baseline central‐line associated blood-stream infection rates. J Paediatr Child Health, 56 (1): 123-9.
25. Clark JE, Graham N, Kleidon T, Ullman A (2019). Taurolidine–citrate line locks prevent recurrent central line–associated bloodstream infection in pe-diatric patients. Pediatr Infect Dis J, 38 (1): e16-e18.
26. German-Diaz M, Maiz-Jimenez M, More-no-Villares JM (2018). Effectiveness of taurolidine in the prevention of cathe-ter-related bacteremia in pediatric pa-tients on home parenteral nutrition. Clin Nutr, 37 (Suppl 1): S272.
27. Hulshof EC, Hanff LM, Olieman J, et al. (2017). Taurolidine in pediatric home parenteral nutrition patients. Pediatr Infect Dis J, 36 (2): 233-5.
28. Klemesrud S, O'Loughlin E, Stormon M, et al. (2017). Use of taurolidine catheter locks for prophylaxis against catheter-related bloodstream infections in chil-dren receiving home parenteral nutri-tion. J Pediatr Gastroenterol Nutr, 32 (Suppl 2): 181.
29. Lambe C, Poisson C, Talbotec C, Goulet O (2018). Strategies to reduce catheter-related bloodstream infections in pedi-atric patients receiving home parenteral nutrition: the efficacy of taurolidine-citrate prophylactic-locking. JPEN J Parenter Enteral Nutr, 42 (6): 1017-25.
30. Łyszkowska M, Kowalewski G, Szymczak M, et al (2019). Effects of prophylactic use of taurolidine-citrate lock on the number of catheter-related infections in children under 2 years of age undergo-ing surgery. J Hosp Infect, 103 (2): 223-6.
31. Merras-Salmio L, Mutanen A, Ylinen E, et al (2018). Pediatric intestinal failure: the key outcomes for the first 100 patients treated in a national tertiary referral center during 1984-2017: original com-munication. JPEN J Parenter Enteral Nutr, 42 (8): 1304-13.
32. Nader E, Lambe C, Talbotec C, et al. (2016). Outcome of home parenteral nu-trition in 251 children over a 14-year pe-riod: report of a single center. Am J Clin Nutr, 103 (5): 1327-36.
33. Nascimento JR, Leite HP, Dos Santos LR, et al (2019). Citrate–taurolidine lock so-lution: impact on the incidence of cath-eter-related bloodstream infections in children with intestinal failure receiving home parenteral nutrition. Transplanta-tion, 103 (7 Suppl 2): S161.
34. Olthof ED, Versleijen MWJ, Huisman-de Waal GJ, et al (2014). Taurolidine lock is superior to heparin lock in the preven-tion of catheter-related bloodstream in-fections and occlusions. PLoS One, 9 (11): e111216.
35. Parmar R, Irving S, Wong S, Tzivinikos C (2018). Cost effectiveness of Taurolock-Hep line lock by reducing catheter re-lated blood stream infections in chil-dren dependent on parenteral nutrition. J Pediatr Gastroenterol Nutr, 66 (Suppl 2): 1024.
36. Rodriguez M, Cordeu M, Álvarez M, et al. (2018). Clinical and economic impact of the taurolidine lock on home parenteral nutrition. Nutr Hosp, 35 (4): 761-6.
37. Saunders J, Naghibi M, Leach Z, et al. (2015). Taurolidine locks significantly reduce the incidence of catheter-related bloodstream infections in high-risk pa-tients on home parenteral nutrition. Eur J Clin Nutr, 69 (2): 282-4.
38. Witkowski M, Silveira RS, Telles AC, et al. (2017). Taurolidine lock vs heparin lock in children and adolescents on chronic parenteral nutrition: results from a ran-domized trial. Transplantation, 101 (6S2): S132.
39. Wouters Y, Theilla M, Singer P, et al. (2018). Randomised clinical trial: 2% tauroli-dine versus 0.9% saline locking in pa-tients on home parenteral nutrition. Al-iment Pharmacol Ther, 48 (4): 410-22.
40. Bianco V, Spera AM, Maraolo AE, et al. (2019). Risk of professional accidental exposure to biological agents in healthcare workers: a retrospective anal-ysis carried out in a southern Italian ter-tiary hospital. Infez Med, 27 (1): 40-5.
41. Chambers A, Mustard CA, Etches J (2015). Trends in needlestick injury incidence following regulatory change in Ontario, Canada (2004–2012): an observational study. BMC Health Serv Res, 15: 127.
42. Garus-Pakowska A, Górajski M, Szatko F (2018). Did legal regulations change the reporting frequency of sharp injuries of medical personnel? Study from 36 hos-pitals in Łódź Province, Poland. Int J Oc-cup Med Environ Health, 31 (1): 37-46.
43. Lu Y, Senthilselvan A, Joffe AM, Beach J (2015). Effectiveness of safety-engineered devices in reducing sharp object injuries. Occup Med (Lond), 65 (1): 39-44.
44. Phillips EK, Conaway M, Parker G, et al (2013). Issues in understanding the im-pact of the Needlestick Safety and Pre-vention Act on hospital sharps injuries. Infect Control Hosp Epidemiol, 34 (9): 935-9.
45. Wu HC, Hsieh ML, Guo YL, et al (2019). Changes in safety needle replacement rate and needlestick injury rate five years after the implementation of Tai-wan's Safety Needle Act. Taiwan Gong Gong Wei Sheng Za Zhi, 38 (5): 509-20.
46. Chaiwarith R, Ngamsrikam T, Fupinwong S, Sirisanthana T (2013). Occupational exposure to blood and body fluids among healthcare workers in a teaching hospital: an experience from northern Thailand. Jpn J Infect Dis, 66 (2): 121-5.
47. Lee JH, Cho J, Kim YJ, et al. (2017). Occu-pational blood exposures in healthcare workers: incidence, characteristics, and transmission of bloodborne pathogens in South Korea. BMC Public Health, 17: 827.
48. Memish ZA, Assiri AM, Eldalatony MM, et al (2013). Risk analysis of needle stick and sharp object injuries among health care workers in a tertiary-care hospital (Saudi Arabia). J Epidemiol Glob Health, 3 (3): 123-9.
49. 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.
50. Garland JS, Alex CP, Mueller CD, Otten D (2001). A randomized trial comparing povidone-iodine to a chlorhexidine glu-conate-impregnated dressing for pre-vention of central venous catheter infec-tions in neonates. Pediatrics, 107 (6): 1431-6.
51. Wall JB, Divito SJ, Talbot SG (2014). Chlorhexidine gluconate-impregnated central-line dressings and necrosis in complicated skin disorder patients. J Crit Care, 29 (6): 1130.e1-4.
52. Kampf G (2019). Adaptive bacterial re-sponse to low level chlorhexidine expo-sure and its implications for hand hy-giene. Microb Cell, 6 (7): 307-20.
53. Kampf G (2016). Acquired resistance to chlorhexidine—is it time to establish an 'antiseptic stewardship' initiative? J Hosp Infect, 94 (3): 213-27.
54. Heimann SM, Biehl LM, Vehreschild JJ, et al (2018). Chlorhexidine-containing dressings in the prevention of central venous catheter-related bloodstream in-fections: a cost and resource utilization analysis. Am J Infect Control, 46 (9): 992-7.
55. Higgins JPT, Thomas J, Chandler J, et al (2019). Cochrane Handbook for System-atic Reviews of Interventions. Version 6.0. London: Cochrane.
56. Opilla M (2008). Epidemiology of blood-stream infection associated with paren-teral nutrition. Am J Infect Control, 36 (10): S173.e5-8.
57. Perry J, Jagger J, Parker G, et al (2012). Disposal of sharps medical waste in the United States: impact of recommenda-tions and regulations, 1987-2007. Am J Infect Control, 40 (4): 354-8.
2. Ye R, Zhao L, Wang C, Wu X, Yan H (2014). Clinical characteristics of septic pulmonary embolism in adults: a sys-tematic review. Respir Med, 108 (1): 1-8.
3. Park DR, Sherbin VL, Goodman MS, et al (2001). The etiology of community‐acquired pneumonia at an urban public hospital: influence of human immuno-deficiency virus infection and initial se-verity of illness. J Infect Dis, 184 (3): 268-77.
4. Tognetti L, Martinelli C, Berti S, et al (2012). Bacterial skin and soft tissue infections: review of the epidemiology, microbiol-ogy, aetiopathogenesis and treatment: a collaboration between dermatologists and infectivologists. J Eur Acad Dermatol Venereol, 26 (8): 931-41.
5. Dunleavy K, Hope V, Roy K, Taylor A (2019). The experiences of people who inject drugs of skin and soft tissue infec-tions and harm reduction: A qualitative study. Int J Drug Policy, 65: 65-72.
6. World Health Organization (2011). Report on the Burden of Endemic Health Care-associated Infection Worldwide. Gene-va: World Health Organization.
7. Lee GH, Moon H, Kim H, et al (2020). Mul-tifunctional materials for implantable and wearable photonic healthcare de-vices. Nat Rev Mater, 5 (2): 149-65.
8. Golestaneh L, Mokrzycki MH (2018). Pre-vention of hemodialysis catheter infec-tions: Ointments, dressings, locks, and catheter hub devices. Hemodial Int, 22 (S2): S75-S82.
9. Piątkowska E, Paleczny J, Dydak K, Letachowicz K (2021). Antimicrobial ac-tivity of hemodialysis catheter lock solu-tions in relation to other compounds with antiseptic properties. PLoS One, 16 (10): e0258148.
10. Wiegers C, Van de Burgwal LH, Larsen OF (2022). Probiotics for the management of infectious diseases: reviewing the state of the art. Front Microbiol, 13: 877142.
11. Leung L (2015). Validity, reliability, and generalizability in qualitative research. J Family Med Prim Care, 4 (3): 324-7.
12. Page MJ, McKenzie JE, Bossuyt PM, et al (2021). The PRISMA 2020 statement: an updated guideline for reporting system-atic reviews. BMJ, 372: n71.
13. Biehl LM, Huth A, Panse J, et al. (2016). A randomized trial on chlorhexidine dressings for the prevention of catheter-related bloodstream infections in neu-tropenic patients. Ann Oncol, 27 (10): 1916-22.
14. Chan RJ, Northfield S, Larsen E, et al. (2017). Central venous access device se-curement and dressing effectiveness for peripherally inserted central catheters in adult acute hospital patients (CAS-CADE): a pilot randomised controlled trial. Trials, 18: 458.
15. Düzkaya DS, Sahiner NC, Uysal G, Yakut T, Çıtak A (2016). Chlorhexidine-impregnated dressings and prevention of catheter-associated bloodstream in-fections in a pediatric intensive care unit. Crit Care Nurse, 36 (1): e1-e7.
16. Ergul AB, Gokcek I, Ozcan A, et al (2018). Use of a chlorhexidine-impregnated dressing reduced catheter-related blood-stream infections caused by gram-positive microorganisms. Pak J Med Sci, 34 (2): 347-51.
17. Gerçeker GÖ, Yardımcı F, Aydınok Y (2017). Randomized controlled trial of care bundles with chlorhexidine dress-ing and advanced dressings to prevent catheter-related bloodstream infections in pediatric hematology-oncology pa-tients. Eur J Oncol Nurs, 28: 14-20.
18. Margatho AS, Ciol MA, Hoffman JM, et al. (2019). Chlorhexidine-impregnated gel dressing compared with transparent polyurethane dressing in the prevention of catheter-related infections in critical-ly ill adult patients: a pilot randomised controlled trial. Aust Crit Care, 32 (6): 471-8.
19. Pedrolo E, Danski MT, Vayego SA (2014). Chlorhexidine and gauze and tape dressings for central venous catheters: a randomized clinical trial. Rev Lat Am Enfermagem, 22 (5): 764-71.
20. Pivkina AI, Gusarov VG, Blot SI, et al. (2018). Effect of an acrylic terpolymer barrier film beneath transparent cathe-ter dressings on skin integrity, risk of dressing disruption, catheter colonisa-tion and infection. Intensive Crit Care Nurs, 46: 17-23.
21. Yu K, Lu M, Meng Y, Zhao Y, Li Z (2019). Chlorhexidine gluconate transparent dressing does not decrease central-line-associated bloodstream infection in crit-ically ill patients: a randomized con-trolled trial. Int J Nurs Pract, 25 (6): e12776.
22. Barnova I, Fragkos K, Morgan S, et al. (2015). Significant reduction in catheter-related bloodstream infections in high-risk adult patients on home PN or IV fluids after introduction of secondary prophylaxis with taurolidine-citrate line lock. Gut, 64 (Suppl 1): A496.
23. Buang SNH, Logarajah V, Lan NS, Liwanag MJ, Bixia A, Ong C (2017). Home paren-teral nutritional support in paediatric chronic intestinal failure -- a single Asian centre experience. Arch Dis Child, 102 (Suppl 2): A119.
24. Chong CY, Ong RYL, Seah VXF, et al. (2020). Taurolidine–citrate lock solution for the prevention of central line‐associated bloodstream infection in paediatric haematology–oncology and gastrointestinal failure patients with high baseline central‐line associated blood-stream infection rates. J Paediatr Child Health, 56 (1): 123-9.
25. Clark JE, Graham N, Kleidon T, Ullman A (2019). Taurolidine–citrate line locks prevent recurrent central line–associated bloodstream infection in pe-diatric patients. Pediatr Infect Dis J, 38 (1): e16-e18.
26. German-Diaz M, Maiz-Jimenez M, More-no-Villares JM (2018). Effectiveness of taurolidine in the prevention of cathe-ter-related bacteremia in pediatric pa-tients on home parenteral nutrition. Clin Nutr, 37 (Suppl 1): S272.
27. Hulshof EC, Hanff LM, Olieman J, et al. (2017). Taurolidine in pediatric home parenteral nutrition patients. Pediatr Infect Dis J, 36 (2): 233-5.
28. Klemesrud S, O'Loughlin E, Stormon M, et al. (2017). Use of taurolidine catheter locks for prophylaxis against catheter-related bloodstream infections in chil-dren receiving home parenteral nutri-tion. J Pediatr Gastroenterol Nutr, 32 (Suppl 2): 181.
29. Lambe C, Poisson C, Talbotec C, Goulet O (2018). Strategies to reduce catheter-related bloodstream infections in pedi-atric patients receiving home parenteral nutrition: the efficacy of taurolidine-citrate prophylactic-locking. JPEN J Parenter Enteral Nutr, 42 (6): 1017-25.
30. Łyszkowska M, Kowalewski G, Szymczak M, et al (2019). Effects of prophylactic use of taurolidine-citrate lock on the number of catheter-related infections in children under 2 years of age undergo-ing surgery. J Hosp Infect, 103 (2): 223-6.
31. Merras-Salmio L, Mutanen A, Ylinen E, et al (2018). Pediatric intestinal failure: the key outcomes for the first 100 patients treated in a national tertiary referral center during 1984-2017: original com-munication. JPEN J Parenter Enteral Nutr, 42 (8): 1304-13.
32. Nader E, Lambe C, Talbotec C, et al. (2016). Outcome of home parenteral nu-trition in 251 children over a 14-year pe-riod: report of a single center. Am J Clin Nutr, 103 (5): 1327-36.
33. Nascimento JR, Leite HP, Dos Santos LR, et al (2019). Citrate–taurolidine lock so-lution: impact on the incidence of cath-eter-related bloodstream infections in children with intestinal failure receiving home parenteral nutrition. Transplanta-tion, 103 (7 Suppl 2): S161.
34. Olthof ED, Versleijen MWJ, Huisman-de Waal GJ, et al (2014). Taurolidine lock is superior to heparin lock in the preven-tion of catheter-related bloodstream in-fections and occlusions. PLoS One, 9 (11): e111216.
35. Parmar R, Irving S, Wong S, Tzivinikos C (2018). Cost effectiveness of Taurolock-Hep line lock by reducing catheter re-lated blood stream infections in chil-dren dependent on parenteral nutrition. J Pediatr Gastroenterol Nutr, 66 (Suppl 2): 1024.
36. Rodriguez M, Cordeu M, Álvarez M, et al. (2018). Clinical and economic impact of the taurolidine lock on home parenteral nutrition. Nutr Hosp, 35 (4): 761-6.
37. Saunders J, Naghibi M, Leach Z, et al. (2015). Taurolidine locks significantly reduce the incidence of catheter-related bloodstream infections in high-risk pa-tients on home parenteral nutrition. Eur J Clin Nutr, 69 (2): 282-4.
38. Witkowski M, Silveira RS, Telles AC, et al. (2017). Taurolidine lock vs heparin lock in children and adolescents on chronic parenteral nutrition: results from a ran-domized trial. Transplantation, 101 (6S2): S132.
39. Wouters Y, Theilla M, Singer P, et al. (2018). Randomised clinical trial: 2% tauroli-dine versus 0.9% saline locking in pa-tients on home parenteral nutrition. Al-iment Pharmacol Ther, 48 (4): 410-22.
40. Bianco V, Spera AM, Maraolo AE, et al. (2019). Risk of professional accidental exposure to biological agents in healthcare workers: a retrospective anal-ysis carried out in a southern Italian ter-tiary hospital. Infez Med, 27 (1): 40-5.
41. Chambers A, Mustard CA, Etches J (2015). Trends in needlestick injury incidence following regulatory change in Ontario, Canada (2004–2012): an observational study. BMC Health Serv Res, 15: 127.
42. Garus-Pakowska A, Górajski M, Szatko F (2018). Did legal regulations change the reporting frequency of sharp injuries of medical personnel? Study from 36 hos-pitals in Łódź Province, Poland. Int J Oc-cup Med Environ Health, 31 (1): 37-46.
43. Lu Y, Senthilselvan A, Joffe AM, Beach J (2015). Effectiveness of safety-engineered devices in reducing sharp object injuries. Occup Med (Lond), 65 (1): 39-44.
44. Phillips EK, Conaway M, Parker G, et al (2013). Issues in understanding the im-pact of the Needlestick Safety and Pre-vention Act on hospital sharps injuries. Infect Control Hosp Epidemiol, 34 (9): 935-9.
45. Wu HC, Hsieh ML, Guo YL, et al (2019). Changes in safety needle replacement rate and needlestick injury rate five years after the implementation of Tai-wan's Safety Needle Act. Taiwan Gong Gong Wei Sheng Za Zhi, 38 (5): 509-20.
46. Chaiwarith R, Ngamsrikam T, Fupinwong S, Sirisanthana T (2013). Occupational exposure to blood and body fluids among healthcare workers in a teaching hospital: an experience from northern Thailand. Jpn J Infect Dis, 66 (2): 121-5.
47. Lee JH, Cho J, Kim YJ, et al. (2017). Occu-pational blood exposures in healthcare workers: incidence, characteristics, and transmission of bloodborne pathogens in South Korea. BMC Public Health, 17: 827.
48. Memish ZA, Assiri AM, Eldalatony MM, et al (2013). Risk analysis of needle stick and sharp object injuries among health care workers in a tertiary-care hospital (Saudi Arabia). J Epidemiol Glob Health, 3 (3): 123-9.
49. 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.
50. Garland JS, Alex CP, Mueller CD, Otten D (2001). A randomized trial comparing povidone-iodine to a chlorhexidine glu-conate-impregnated dressing for pre-vention of central venous catheter infec-tions in neonates. Pediatrics, 107 (6): 1431-6.
51. Wall JB, Divito SJ, Talbot SG (2014). Chlorhexidine gluconate-impregnated central-line dressings and necrosis in complicated skin disorder patients. J Crit Care, 29 (6): 1130.e1-4.
52. Kampf G (2019). Adaptive bacterial re-sponse to low level chlorhexidine expo-sure and its implications for hand hy-giene. Microb Cell, 6 (7): 307-20.
53. Kampf G (2016). Acquired resistance to chlorhexidine—is it time to establish an 'antiseptic stewardship' initiative? J Hosp Infect, 94 (3): 213-27.
54. Heimann SM, Biehl LM, Vehreschild JJ, et al (2018). Chlorhexidine-containing dressings in the prevention of central venous catheter-related bloodstream in-fections: a cost and resource utilization analysis. Am J Infect Control, 46 (9): 992-7.
55. Higgins JPT, Thomas J, Chandler J, et al (2019). Cochrane Handbook for System-atic Reviews of Interventions. Version 6.0. London: Cochrane.
56. Opilla M (2008). Epidemiology of blood-stream infection associated with paren-teral nutrition. Am J Infect Control, 36 (10): S173.e5-8.
57. Perry J, Jagger J, Parker G, et al (2012). Disposal of sharps medical waste in the United States: impact of recommenda-tions and regulations, 1987-2007. Am J Infect Control, 40 (4): 354-8.
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How to Cite
1.
Zhang H, He J, Ke F, Li M, Yao W. Determining the Effectiveness of Preventive Measures in Reducing Intravenous Injection and Catheter-Related Infections: A Meta-Analysis. Iran J Public Health. 2025;54(12):2595-2607.
