This white paper attempts to provide relevant information emphasizing the need to establish the prevention of Hospital-Onset Bacteremia (HOB), an evolving and broad prevention concept that addresses all IV catheters and that may be advanced with use of evolutionary antimicrobial dressings.
Published in the Journal of Wound Care, Volume 29. Number 5. May 2020.
The aim of this study was to investigate the in vitro antimicrobial performance of a chlorhexidine diacetate dressing and a chlorhexidine free base dressing (PrevahexCHX) to determine if the free base form of chlorhexidine had the potential to be an effective alternative for antimicrobial dressings.
Dressing samples were inoculated with clinically relevant pathogenic microorganisms commonly found at wound and catheter sites, including gram-positive and gram-negative bacteria, yeasts and fungus, and subsequently evaluated for in vitro log10 reduction at 1-, 3- and 7-day time points.
The chlorhexidine free base dressing demonstrated >0.5 log10 superior mean antimicrobial efficacy at 67% of the experimental time points and equivalent mean antimicrobial efficacy (≤0.5 log10 different) at the remaining time points when compared with the chlorhexidine diacetate dressing. These results indicate that a dressing formulated with chlorhexidine free base can deliver in vitro antimicrobial performance at both a magnitude and rate that meets or exceeds that of a chlorhexidine diacetate-based dressing.
In the fall of 2019, a prospective multimodal comparator study was published in the Journal of the Association for Vascular Access (JAVA) in which Lee Steere, RN, CRNI®, VA-BC™ from Hartford Hospital (867-bed urban level 1 trauma center) implemented a vascular access specialist team and bundled approach to peripheral IV catheters called the PIV 5 Rights (PIV5R) to increase dwell time and decrease complications.
PIV catheter failure rates and complication incidence are as high as 53%, with approximately 1 out of every 2 catheters failing to make it to 5 days or to the end of treatment. These high failure rates are a result of common PIV complications (infiltration, extravasation, phlebitis, catheter occlusion, CR-BSIs and dislodgment). He was able to achieve an 89% success rate of the catheter staying in until the end of treatment vs. 15% which was standard practice.
PrevahexCHX dressing was part of the technology bundle that was implemented in the PIV5R group. It was chosen specifically as a critical component to protect the site by helping to prevent avoidable complications, like CR-BSIs, phlebitis and infiltrations, and to stabilize the catheter to prevent dislodgement. The study was powered by 210 sites to be compared; 207 were used (113 in the PIV5R group, 94 in the standard practice group).
The PrevahexCHX dressing lasted 96% of the time for the full duration of therapy vs the standard dressing only lasted 55% of the time. The complication rate for the overall study was only 11% in the PIV5R group vs. 40% in the standard practice group. Out of the 11% of complications in the PIV5R group, the PrevahexCHX dressing was NEVER cited as a contributing site symptomatic issue. In addition, there were no instances of site irritation, allergic reaction, or adverse events reported. The PrevahexCHX dressing was significantly more likely to last to therapy completion and contributed to lower overall phlebitis and infiltration rates, likely due to its prolonged suppression of bacterial growth. Lastly, the PIV5R group led to significant cost savings for Hartford Hospital. Even though the supplies cost more, and they used highly skilled nurses, it was proven to save the hospital $3300/bed/year.