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Simple Approach to Preventing Catheter-Related Infections

Chlorhexidine-impregnated sponges cut the infection rate in half.

Catheter-related infections, particularly those associated with central venous catheters (CVCs) in intensive care unit patients, are a major cause of morbidity (80,000 infections annually in the U.S.), mortality (24,000 deaths annually), and cost (US$18,000 per infection). Precautions that significantly lower risk for infection include not using the femoral vein for CVCs, maximal sterile technique, and prompt removal of unnecessary catheters.

French investigators conducted a randomized study of whether chlorhexidine-impregnated sponges would prevent infections in 1636 ICU patients who received either arterial catheters or CVCs (3778 catheter placements). Sponges were placed over the catheter insertion sites at the time of insertion and were replaced with each dressing change; median duration of catheter use was 6 days. The incidence of major catheter-related infections decreased from an already-low baseline level of 1.0% in the control group (19 infections per 1825 catheters) to 0.5% in the sponge group (10 infections per 1953 catheters). The only major adverse event was severe contact dermatitis, which occurred in eight sponge patients.

The researchers also compared 3-day intervals with 7-day intervals for dressing changes (in a 2x2 design). They found no difference in infection rates, but the actual frequency of dressing changes was similar in the groups because of soiled and leaking dressings.

Comment: The main lesson of this study is that a simple intervention can significantly lower the rate of CVC-related infections even when the baseline rate is already low. The absolute risk reduction is small (number needed to treat, 117), but the low cost of these sponges still allows this intervention to be cost-effective.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine April 9, 2009

Citation(s):

Timsit J-F et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: A randomized controlled trial. JAMA 2009 Mar 25; 301:1231.

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