Use of dry dressings for central venous access devices (CVADs) to decrease central line-associated blood stream infections (CLABSI) in a trauma intensive care unit (ICU)
This article reports the results of a pre-post study conducted in a trauma-medical-surgical intensive care unit (ICU) regarding dressings of central venous access devices (CVADs) for the reduction of central line-associated blood stream infection (CLABSI) and improvement of adherence and integrity of the dressing. Available evidence indicates that dry dressings changed every 48 hours are equivalent to transparent dressings, changed when soiled or loose, or routinely every seven days. In our intensive care unit, where the majority of CVADs are inserted in the internal jugular vein and where there is an important usage of cervical collars, we questioned if dry dressings would be more appropriate than transparent dressings.
In the 12 months following the change in practice, we noted a CLABSI reduction from 2.36/1,000 catheter days to zero, improvement in dressing audits from 19.61% to 85.34% of clean dressings (P=0.00001) and 62.75% to 90.58% of adherent dressings. Conclusion: In this pre-post study, a simple change in dressing type was implemented, resulting in a significant reduction in the CLABSI rate.
Interventions aiming at reducing the incidence of central line-associated blood stream infections (CLABSI) have been well described in the literature, as strategies to reduce morbidity, mortality and associated cost with the provision of care (Bell et al., 2012; O'Grady et al., 2011; Gorski et al., 2016). Bundles of interventions targeting insertion and maintenance have demonstrated effectiveness (Bell et al., 2012). Maintenance intervention measures include assessment of insertion site with prompt dressing change when soiled, damp or non-adherent, reduction of unnecessary catheter access, appropriate disinfection of the connector with every access, removal of the catheter when no longer needed, and proper flushing of the device (Bell et al., 2012; O'Grady et al., 2011; Gorski et al., 2016; Ferroni et al., 2014).
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