Catheter-Related Bloodstream Infections during Use of Chlorhexidine Gluconate-Impregnated Dressings

Topic Significance & Study Purpose/Background/Rationale

Surveillance blood cultures aim maximum reduction of unnecessary harm associated with health care. Catheter-related bloodstream infections (CBSI) are a preventable problem, which should be considered when aiming at patient safety. In this context, chlorhexidine gluconate-impregnated dressings (CHXGID) are a current technology that has been found favorable in the prevention of CBSI.

The present study aims to identify the occurrence of CBSI during the use of CHXGID in patients under treatment with hematopoietic stem cell transplantation (HSCT). 

Methods, Intervention, & Analysis

Cross-sectional study with patients who used CHXGID as coverage for the central venous catheter. CBSI was confirmed through the difference higher than two hours in time of positivity between  blood cultures from the proximal and distal catheter ends or through the presence of the same microorganism at the end of the catheter and in the blood stream culture, besides verification of clinical infection at the exit site by means of inspection and palpation. 

Findings & Interpretation

A total of 39 patients were evaluated from September 2013 to June 2014. Of these, 22 (56%) underwent allogeneic and 17 (44%), autologous HSCT. Twenty (51%) used double lumen catheters, which were inserted predominantly in the internal jugular vein (79%). CBSI was confirmed in 12 patients. In addition, there were three clinically overt infections, namely one case of tunnel infection and two cases of exit site infection. Of all catheter-related infections, nine occurred in patients who underwent autologous transplantation. Gram-negative bacteria were the main microorganisms, the most frequent being Klebsiella pneumonia, isolated in three cases. 

Discussion & Implications 

CBSI occurred despite of the use of a dressing indicated to control local microbiota and prevent infections. Of note, the identified microorganisms were not natural of the skin reservoir. This finding, added to the infectious vulnerability of the studied population, instigates the development of experimental studies which aim to assess the efficacy and cost-benefit of CHXGID to reduce infection in patients submitted to HSCT. Moreover, prevention of infections cannot be solely associated with the use of a protective device, but with the adoption of a combination of  recommended measures, such as hand hygiene before using a catheter.