use chlorhexidine dressings to decrease CLABSI

More than 23,000 CLABSIs were reported in the United States in 2022. A number of strategies, both during and after central venous catheter (CVC) insertion, have been explored for CLABSI prevention. Chlorhexidine is an antiseptic with broad-spectrum antimicrobial activity. The use of chlorhexidine-containing dressings can reduce the risk of CLABSI by up to 33% and is now considered an “essential practice” for CLABSI prevention (choice B is correct).

Selection of the subclavian vein is associated with a decreased rate of infectious complications compared with both the internal jugular and femoral veins for catheters placed in the ICU setting (choice A is incorrect). It is unknown whether the internal jugular vein is preferable to the femoral vein in this regard. Although cumulative risk of CLABSI increases with catheter duration, daily incidence of CLABSI does not. Consequently, although timely removal of unnecessary CVCs is crucial, routine line replacement after any specific number of catheter days is not recommended (choice C is incorrect). It is unclear whether routinely changing the dressing every 3 days has any effect on CLABSIs in comparison with longer intervals, and repeated removal and application of dressings can cause damage to the surrounding skin (choice D is incorrect). Recommendations are to change dressings routinely every 7 days, or sooner if the dressing is soiled, damp, or loose.1234567

Footnotes

  1. SEEK Questionnaires ↩

  2. Buetti N, Marschall J, Drees M, et al. Strategies to prevent central line-associated bloodstream infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol. 2022;43(5):553-569. PubMed ↩

  3. Centers for Disease Control and Prevention. Current HAI Progress Report: 2022 National and State Healthcare-Associated Infections Progress Report. Accessed March 31, 2024. https://www.cdc.gov/hai/data/portal/progress-report.html ↩

  4. Gavin NC, Webster J, Chan RJ, et al. Frequency of dressing changes for central venous access devices on catheter-related infections. Cochrane Database Syst Rev. 2016;2(2):CD009213. PubMed ↩

  5. Parienti JJ, Mongardon N, Mégarbane B, et al; 3SITES Study Group. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015;373(13):1220-1229. PubMed ↩

  6. Puig-Asensio M, Marra AR, Childs CA, et al. Effectiveness of chlorhexidine dressings to prevent catheter-related bloodstream infections. Does one size fit all? A systematic literature review and meta-analysis. Infect Control Hosp Epidemiol. 2020;41(12):1388-1395. PubMed ↩

  7. Timsit JF, Rupp M, Bouza E, et al. A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med. 2018;44(6):742-759. PubMed ↩