To investigate the feasibility and safety of comparing two antimicrobial impregnated discs to prevent CLABSI” Webster et al (2017).
Background: A number of antimicrobial impregnated discs to prevent central-line associated blood stream infection (CLABSI) are marketed but it is unclear which disc is most effective.
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Aim: To investigate the feasibility and safety of comparing two antimicrobial impregnated discs to prevent CLABSI.
Methods: We conducted a single-centre, parallel group, randomised controlled trial in a 929-bed, tertiary referral hospital. Hospital in-patients requiring a peripherally inserted central catheter were randomised to chlorhexidine gluconate (CHG) or polyhexamethylene biguanide (PHMB) disc dressing group. Dressings were replaced every 7-days, or earlier, if clinically required. Participants were followed until device removal or hospital discharge. Feasibility outcomes included: proportion of potentially eligible participants who were enrolled; proportion of protocol violations; and proportion of patients lost to follow-up. Clinical outcomes were: CLABSI incidence, diagnosed by a blinded infection control practitioner; all cause BSI; and product-related adverse events.
Findings: Of 143 patients screened, 101 (42%) were eligible. Five (3.5%) declined participation. There was one post-randomisation exclusion. Two (2%) protocol violations occurred in the CHG group. No patients were lost to follow-up. Three (3%) blood stream infections occurred; two (2%) were confirmed CLABSIs (one in each group) and one a mucosal barrier injury-related BSI. 1217 device days were studied; resulting in 1.64 CLABSI/1000 catheter days. One (1%) disc-related adverse events occurred in the CHG group.
Conclusion: Disc dressings containg PHMB are safe to use for infection prevention at catheter insertion sites. An adequately powered trial to compare PHMB and CHG discs is feasible.
Webster, J., Larsen, E., Marsh, N., Choudhury, M.A., Harris, P. and Rickard, C.M. (2017) Chlorhexidine gluconate or polyhexamethylene biguanide disc dressing to reduce the incidence of Central-Line-Associated Blood Stream Infection: a feasibility randomised controlled trial (the CLABSI trial). The Journal of Hospital Infection. April 15th. [epub ahead of print].
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