Reducing catheter-related bloodstream infections : chlorhexidine-based vs standard simple dressings

Abstract

Overview: Catheter-related bloodstream infections (CRBSI) linked with the use of central venous catheters (CVCs), are associated with increased morbidity and mortality and pose a financial burden on the healthcare system. This dissertation evaluates the effectiveness of chlorhexidinebased CVC dressings on reducing CRBSI incidence. The Research Question: This dissertation focused on the following Population-Intervention Comparison-Outcome (PICO) question: In hospitalized patients with central venous catheters in situ for treatment administration (P), are chlorhexidine-based dressings (I) effective in reducing the incidence of catheter-related bloodstream infections (O) when compared with standard, simple dressings (C)? Method: Key terms related to the research question such as ‘CVC’, ‘chlorhexidine’ and ‘CRBSI’ were identified and combined with Boolean operators, search tools and limiters. The search was conducted using health-based research platforms (EBSCO, MEDLINE ProQuest) and databases (Scopus, PubMed) as well as an internet search-engine (Google Scholar). Eligibility criteria were applied, including articles written in English with either a systematic review, meta-analytical or randomized control trial (RCT) study design that directly compared CRBSI incidence between the two dressing types. Four systematic reviews with meta-analysis and four randomized control trials were retrieved. For critical appraisal, the ‘Critical Appraisal Skills Program’ (CASP) tools for Systematic reviews and RCTs were utilized. Results: All eight studies found a reduction in CRBSI occurrence on using chlorhexidine-based CVC dressings, with six studies reporting statistically significant results. Conclusion: Findings concluded that chlorhexidine-based CVC dressings reduce CRBSI incidence. Further research should focus on investigating this intervention using different catheter types and locations since infection risk is not uniform. Implications and Recommendations: Infection control guidelines should be updated to reflect these findings. The involvement of specialist nurses to educate healthcare workers together with audits can occur to promote infection prevention measures on handling CVCs.