Ruschulte, H., Franke, M., Gastmeier, P., Zenz, S., Mahr, K.H., Buchholz, S., . . . Piepenbrock, S. (2009). Prevention of central venous catheter related infections with chlorhexidine gluconate impregnated wound dressings: A randomized controlled trial. Annals of Hematology, 88, 267–272. 

To evaluate the effectiveness of chlorhexidine sponges in prevention of central venous catheter infections inserted for cancer chemotherapy

All patients received chlorhexidine and silver-impregnated, triple-lumen central venous catheters (CVC) that were intended for at least five-day use. Catheter insertion was done using maximal barriers, and skin antisepsis was done with alcohol. Catheter dressings were changed weekly. Patients expected to have catheters in place for less than five days were not included in the study.

• N = 601   
• MEDIAN AGE = 47
• AGE RANGE = 18–73
• MALES: 55.4%, FEMALES: 44.6%
• CURRENT TREATMENT: Chemotherapy
• KEY DISEASE CHARACTERISTICS: All had hematological malignancies
• OTHER KEY SAMPLE CHARACTERISTICS: The majority had CVCs placed in the internal jugular vein

• SITE: Single site   
• SETTING TYPE: Inpatient    
• LOCATION: Germany

• PHASE OF CARE: Active antitumor treatment

• Stated randomized, controlled trial

• Diagnosis of central line–associated bloodstream infection (CLABSI) was made based on clinical assessment symptoms of fever, swelling, and/or hypotension for which no other source was identified.

Mean catheter duration was 15.8 days among controls and 16.6 days in the experimental group. Among the treatment group were 19 cases of CVC infection (3.8 per 1,000 catheter days) compared to 34 cases (7 per 1,000 catheter days) in the control group (p = 0.016).

The use of chlorhexidine-impregnated dressings was associated with a lower rate of catheter-related infections.

• Risk of bias (no blinding)
• Measurement/methods not well described
• No information on the chemotherapy agents used
• Unclear definition of catheter-related infection by clinical determination
• Stated as an RCT, but randomization was not described and usual care not described 
• Stated that experienced clinician inserted the experimental group catheters, and procedure described
• Information about insertion or sites for \"control\" group was not described.

This study demonstrated supportive evidence for efficacy of chlorhexidine-impregnated dressings in CVC care to reduce the incidence of catheter-related infections. Patients with hematologic cancers receiving chemotherapy as included here are generally at high risk for infection. Interventions that can reduce the risk of infection in this patient population are important to incorporate into practice.