Clinical Guidelines
The following clinical guidelines offer support and recommendations for the use of chlorhexidine-impregnated dressings to prevent and reduce incidence of catheter-related bloodstream infections (CRBSls) and surgical site infections (SSls).
Chlorhexidine-Impregnated Dressings for the Prevention of CRBSI Category IA
These special approaches are recommended for use in locations and/or populations within the hospital with unacceptably high CLABSI rates despite implementation of the basic CLABSI prevention strategies listed above. These measures may not be indicated if institutional goals have been consistently achieved. [...]2. Use chlorhexidine-containing dressings for CVCs in patients over 2 months of age.
Catheter Site Dressing Regimens - If the CLABSI rate is not decreasing despite successful adherence to basic prevention measures (education and training, appropriate use of chlorhexidine for skin antisepsis, and maximum sterile barrier precautions), guidelines also recommend using a chlorhexidine-impregnated sponge dressing for temporary short-term catheters in patients older than 2 months of age.14,18
Consider the use of a chlorhexidine impregnated sponge dressing in adult patients with a central venous catheter as a strategy to reduce catheter related bloodstream infection. New recommendation Class B.
Use chlorhexidine-impregnated dressings for all patients 18 years and older with short-term nontunneled CVADs. Use for arterial catheters and other CVADs when all other CABSI prevention strategies have proven ineffective.
Consider the use of chlorhexidine-impregnated dressings for patients with an epidural access device. A significant reduction in epidural skin colonization and catheter tip colonization has been demonstrated with their use.
A sterile dressing, combined or integrated with a securement device appropriate for patient’s condition and patient’s preference, is maintained on all peripheral and central VADs to protect the site, provide a microbial barrier, and promote skin health and VAD securement.
Use a securement method, such as integrated securement device (ISD), to stabilize and secure VADs.
The consultants and ASA members agree that dressings containing chlorhexidine may be used to reduce the risk of catheter-related infection.
Unless contraindicated, catheter insertion site dressings containing chlorhexidine may be used in adults, infants, and children.
1 Centers for Disease Control and Prevention. 2017. Recommendations on use of chlorhexidine-impregnated dressings for prevention of intravascular catheter-related infections
2 Marschall J, et al. 2014. Strategies to Prevent Central Line Associated Bloodstream Infections in Acute Care Hospitals. SHEA/IDSA Practice Recommendations
3 The Joint Commission. Preventing Central Line–Associated Bloodstream Infections: A Global Challenge, a Global Perspective. Oak Brook, IL: Joint Commission Resources, May 2012.
4 J Hosp Infect. 2014 Jan;86 Suppl 1:S1-70. doi: 10.1016/S0195-6701(13)60012-2.
5 Ullman AJ, Cooke ML, Mitchell M, Lin F, New K, Long DA, Mihala G, Rickard CM. Dressings and securement devices for central venous catheters (CVC). Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD010367. DOI:10.1002/14651858.CD010367.pub2. http://www.ncbi.nlm.nih.gov/pubmed/26358142--
6 Infusion Nurses Society. (2021) INS standards of Practice. Journal of Infusion Nursing.
7 Copyright © 2012, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology 2012; 116:539 –73 (?)
14 O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011 May;52(9):e162–193. Epub 2011 Apr 1.
18 Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Calfee DP, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Klompas M, Lo E, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Strategies to prevent central line–associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol. 2008 Oct;29 Suppl 1:S22–30. Erratum in: Infect Control Hosp Epidemiol. 2009 Aug;30(8):815.