Salon 2 14 kasim 15.30 17.00 duygu sönmez düzkaya-ing1

1. A Randomized Controlled Study: Can Chlorhexidine-
Impregnated Dressings Prevent Central Venous
Catheter Associated Bloodstream Infections in the
Pediatric Intensive Care Unit?
1Dr. Duygu Sönmez Düzkaya, 2Yrd. Doç. Dr. Nejla Canbulat Şahiner, 3Hem.
Tülay Yakut, 4Yrd. Doç. Dr. Gülzade Uysal, 3Prof. Dr. Agop Çıtak
1Istanbul University, Istanbul Faculty of Medicine, Directorate of Nursing Services, Turkey
2Karamanoğlu Mehmet Bey University, Nursing Department, Turkey
3Istanbul University, Istanbul Faculty of Medicine, Pediatric Intensive Care Unit, Turkey
4Okan University School of HealthSciences, Turkey

2. BBAACCKKGGRROOUUNNDD
• Bloodstream infections related to use of
catheters are associated with increased
morbidity and mortality rates prolong hospital
length of stay (LOS) and increase medical
costs.

3. AAiimm
• To compare the efficacy of chlorhexidine
impregnated dressing with standard dressings
solution in preventing catheter-related
bloodstream infection.

4. MMeetthhooddss
• This prospective, randomized, controlled
experimental study was undertaken in a
university hospital’s pediatric intensive care
unit (PICU) between December 2012, and
January 2014.
• The trial was approved by the Ethics
Committee.

5. MMeetthhooddss
• In total, 100 patients were enrolled into the
study;
• 50 patients with chlorhexidine impregnated
dressings (chlorhexidine group), and
• 50 patients with standard dressings (standard
group).

6. MMeetthhooddss
Inclusion criteria;
• Patient age of between 1 mounth-18year old,
• Provided the treating physician felt the
inserted catheter would be present for a
minimum of 72h.,
• CVCs inserted in PICU
• Don’t use neuromuscular-blocking drugs
• Have volunteered to participate in the study.

7. MMeetthhooddss
• Standard group;
• The dressings of the standard group were changed
in accordance with standard clinical care.
• Each patient’s skin was disinfected with a 10%
povidone-iodine solution 3 min and allowed to
dry.

8. MMeetthhooddss
• Chlorhexidine group;
• Catheter care Each patient’s skin was disinfected
with a 10% povidone-iodine solution 3min and
allowed to dry.
• The chlorhexidine group’s dressings were changed
every seven days.

9. MMeetthhooddss
• Both group;
– Installing or removing a central venous catheter
care guide use
– The catheter was inserted to comply with aseptic
technique.
– After inserting catheter whilethe patient's daily
body care was taken to wet the pad.
– Daily follow-up form was performed.

10. MMeetthhooddss
• Catheter site was observed on a daily basis.
• Catheter blood cultures before retiring, the
catheter is pulled and sent to a laboratory
breeding status of peripheral blood cultures
were evaluated.

11. Defination
Catheter tip Central Catheter
hemoculture
Peripheral catheter
blood cultures
Result
No growth No growth
or the same patogen
with peripheral blood
culture
No growth
or the same
patogen with
central catheter
blood culture
Sterile catheter
Reproduction(<
15 cfu)
No growth
or different patogen
with catheter tip
No growth Contamination
Reproduction
(≥ 15 cfu)
different patogen with
catheter tip
different patogen
with catheter tip
Colonization
Reproduction Reproduction
He same patogen with
catheter tip
No growth Catheter-related
bloodstream
infection
Signs of inflammation over the catheter entry semiquantitative culture of the catheter
tip with 15 cfu local catheter infection in case of reproductive factors (LK)

12. RReessuullttss
100 patient
50 standard group 50 chlorhexidine group
Randomization
-Patients;
- 53 % 1 mounth-1 year old,
-60 % male,
-32 % respiratory system diseases
-56% were found to have additional disease

13. RReessuullttss
Central Venous Catheter colonization
4 (%8) standard group 1 (%2) chlorhexidine group
(p>0, 05)

14. RReessuullttss
Local catheter infection
5 (%10) standard group 4 (%8) chlorhexidine group
(p>0, 05)

15. RReessuullttss
Catheter-related bloodstream infection
5 (%10) standard group 1 (%2) chlorhexidine group
(p>0, 05)

16. RReessuullttss
Catheter closure
product
The duration of intensive
care
Duration of stay on
mechanical ventilation
The duration of the
catheter
(p>0, 05)

17. CONCLUSIONS AANNDD RREECCOOMMMMEENNDDAATTIIOONNSS
• 2% chlorhexidine impregnated dressings reduce the
rates of CVC bloodstream infections and colonization
in the pediatric intensive care unit.
• Although these results were not statistically
significant, They are clinically important.
• It s recommended that 2% chlorhexidine
impregnated dressings can used in PICU.

18. THANK YOU