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Chlorhexidine-impregnated transparent dressings decrease catheter-related infections in hemodialysis patients: a quality improvement project

Abstract

Purpose

Central venous catheters (CVC) are associated with increased infection rates, morbidity and mortality compared to other hemodialysis vascular access. Chlorhexidine-impregnated transparent (CHG-transparent) dressings allow for continuous antimicrobial exposure and easy visibility of the CVC insertion site. We conducted a quality improvement project to compare catheter-related infection (CRI) rates in two dressing regimens – CHG-transparent dressings and adhesive dry gauze dressing in hemodialysis patients with tunneled CVCs.

Methods

The study was conducted in two phases. In phase 1, CHG-transparent dressing was introduced to EDC hemodialysis unit, while EDG and EDN hemodialysis units, served as the control sites and maintained adhesive dry gauze dressing. Phase 2 of the study involved replacing the adhesive dry gauze dressing with CHG-transparent dressing at EDG and EDN and maintaining CHG-transparent dressing at EDC. CRI rates at each hemodialysis unit during the 12-month intervention were compared to CRI rates for the 12-month pre-intervention period for each study phase. CRI rates were also compared between all three hemodialysis units.

Results

In phase 1, CRI rates (per 1000 days) in EDC (intervention site) decreased by 52% (1.69 vs. 0.82, p<0.05) and increased by 12% (1.80 vs. 2.02, p = 0.75) at EDG, and 35% (0.91 vs. 1.23, p = 0.40) at EDN. In phase 2, CRI rates at EDG and EDN (intervention sites) decreased by 86% (1.86 vs. 0.26 p<0.05), and 53% (1.89 vs. 0.88, p<0.05), respectively, and decreased by 20% at EDC (0.73 vs. 0.58, p = 0.65).

Conclusions

Replacing adhesive dry gauze dressing with CHG-transparent dressing for hemodialysis patients with tunneled CVC was associated with decreased CRI rates.

J Vasc Access 2017; 18(2): 103 - 108

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.5301/jva.5000658

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Authors

Ibironke W. Apata, John Hanfelt, James L. Bailey, Vandana Dua Niyyar

Article History

Disclosures

Financial support: Partially supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454.
Conflict of interest: None of the authors has financial interest related to this study to disclose.
Meeting presentation: This work was presented in part at the annual meetings of the National Kidney Foundation, 2014, and American Society of Nephrology, 2015.

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Authors

Affiliations

  • Emory University School of Medicine, Atlanta, Georgia - USA
  • Rollins School of Public Health, Emory University, Atlanta, Georgia - USA

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