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Table 1 the characteristics of included studies

From: Chlorhexidine-impregnated dressing for the prophylaxis of central venous catheter-related complications: a systematic review and meta-analysis

Author(year)

Country

Population

Numbers of participants(Chlorhexidine / Control)

Catheter Type

Chlorhexidine-impregnated dressing Intervention

Definition of Catheter Colonization

Definition of CRBSI

Conclusion

Arvaniti 2012

Greece

ICU patients who required a CVC for ≥3 days

150/156

CVC

after the first 24 h of catheterization, a Biopatch was placed underneath the transparent dressing, And the Biopatch was changed every 3 days,

Quantitative CVC tip culture with > 1000 CFU/mL and no systemic signs of sepsis

Quantitative CVC tip culture with > 1000 CFU/mL with systemic signs of sepsis

Chlorhexidine-impregnated sponges and Oligon catheters as single preventive measures did not reduce catheter colonization or catheter-related infections.

Biehl 2016

Germany

Patients undergoing chemotherapy with an expected duration of chemotherapy- induced neutropenia of ≥5 days and an expected CVC use of ≥10 days

307/306

Non-tunneled CVC

Dressings were applied within 2 h of CVC placement and changed every 3 ± 1 days.

Not availabe

The results from blood and CVC tip cultures

The application of chlorhexidine containing catheter securement dressings reduces the incidence of definite or probable CRBSI in neutropenic patients.

Chambers 2005

New Zealand

Adult patients undergoing chemotherapy in a haematology unit.

58/54

Long-term, tunneled and cuffed CVC

The Chlorhexidine impregnated dressing were applied to the exit site as soon the oozing had stopped following intravascular catheter insertion, and changed as needed or weekly.

Not available

Fever and positive blood cultures without alternative infection source and catheter tip culture with > 15 colonies of the same organism

Chlorhexidine dressings reduced the incidence of exit-site/tunnel infections of indwelling tunnelled intravascular catheters without prolonging catheter survival in neutropenic patients

Garland 2001

USA

ICU neonates with CVC expected to remain in place a minimum of 48 h

335/370

CVC and tunneled (Broviac) CVC

The Chlorhexidine impregnated dressing were applied after catheterization and changed for every 7 days or as needed.

Semiquantitative catheter colony count > 15 CFU

Clinical infection with same organism isolated from catheter tip and blood

The Chlorhexidine impregnated dressing is effective in protect against the catheter-tip colonization.

Gereker 2017

Turkey

Pediatric hematologyoncology (PHO) population over 2 months of age with expected CVC duration over 48 h

14/13

CVC

Care bundle with Chlorhexidine impregnated dressing being used

Not availale

Blood culture

There was no difference between the two groups with chlorhexidine dressing or advanced dressings in terms of CRBSI

development.

Levy 2005

Israel

Cardiac ICU pediatrics requiring CVC for minimum of 48 h

74/71

Short-term, nontunneled CVC

The Chlorhexidine impregnated dressing were applied after catheterization and changed whenever needed.

>  15 CFU by the roll-plate technique, no signs of infection

Bacteremia with isolation of the same organism from CVC tip and blood

The Chlorhexidine impregnated dressing is safe and significantly reduces the rates of CVC colonization in infants and children after cardiac surgery.

Pedrolo 2014

Brazil

Adult ICU patients

43/42

CVC

chlorhexidine antimicrobial dressing was changed every 7 days

Not available

Infection variables: temperature > 38 °C, systolic blood pressure < 90 mmHg, oliguria< 20 ml/h, tenderness, pain or swelling on palpation, hyperemia, cyanosis or discharge at the catheter opening; And further verified by blood culture or a culture of the catheter tip

The chlorhexidine antimicrobial dressing is not effective in reducing primary bloodstream infection when compared to the gauze and tape dressing.

Roberts 1998

Australia

Adult ICU patients receiving CVC over a 7-week period

17/16

CVC

Chlorhexidine impregnated dressing was changed every fifth day or as needed.

Same organism from CVC tip and exit site, no clinical infection

Clinical infection with same organism isolated from catheter tip (and/or exit site) and blood

No statistical difference was found between the two groups with regard to CVC or exit-site colonisation.

Ruschulte 2008

Germany

Adults receiving chemotherapy with catheter expected for minimum of 5 d

300/301

Triple-lumen CVC

The Chlorhexidine impregnated dressing were applied after catheterization

Not available

Clinical evidence of infection and time-to-positivity method used with CVC and peripherally drawn blood cultures

The use of chlorhexidine-impregnated wound dressings significantly reduced the incidence of CVC-related infections in patients receiving chemotherapy.

Timsit 2009

France

Adult ICU patients requiring catheter minimum of 48 h

817/819

CVC and/ or arterial catheter

The Chlorhexidine impregnated dressing was changed 24 h after catheter insertion (day 1) and then every 3 days in the 3-day group and every 7 days in the 7-day group

Quantitative CVC tip culture ≥1000 CFUs/mL

Clinical infection without alternative source, peripheral blood drawn immediately prior to or within 48 h following catheter removal and quantitative catheter tip culture isolating the same organism, or confirmed using differential time to positivity test

The use of Chlorhexidine impregnated dressings decreased the risk of major catheter- related infections by 60% despite a low baseline infection rate.

Timsit 2012

France

ICU patients with vascular catheters inserted for an expected duration of more than 48 h

938/476

CVC

The dressings were changed 24 h after catheter insertion (Day 1) then every 3 or 7 days according to standard practice in each ICU

Quantitative CVC tip culture > 1000 CFU/mL and no systemic signs of sepsis

Correlation between peripheral blood culture and quantitative tip culture without other likely source

The Chlorhexidine-impregnated gel dressings decrease by 60% the risk of CRBSI in the ICU.

Yu 2015

China

Adult internal ICU patients

189/162

CVC

Chlorhexidine impregnated dressing was changed every 7 days or as needed.

Not available

Infection variables: blood cultures or catheter tip cultures

The Chlorhexidine impregnated dressing cannot effectively reduce the incidence of CLABSI, and the cost is higher, but it can effectively reduce the number of dressing changes and save labor costs

  1. ICU intensive care unit, CVC Central venous catheter, CLABSI catheter-related bloodstream infection