HD catheters - dressing or no?

[kdunurse]

Our facility uses the standard CDC policy for central line dressing changes (q48h for gauze, q7 days and prn for occlusive), but our clinical coordinator has said there is research indicating that infections are lower when no dressing is used. I can't find any information about this online. Has anyone heard of this?

[traumaRUs, MSN, APRN]

Heres what I got from UpToDate:

SITE CARE

Insertion site preparation — Use of antiseptic solution for skin disinfection at the catheter insertion site helps prevent catheter-related infection. Chlorhexidine-based solutions (>0.5 percent chlorhexidine preparation with alcohol) appear to be superior to both aqueous and alcohol-based povidone-iodine in reducing the risk for catheter colonization and catheter-related bloodstream infection [72-74]. This was illustrated in a meta-analysis of eight randomized trials including 4143 catheter insertions; disinfection with chlorhexidine rather than aqueous povidone-iodine resulted in a 50 percent reduction in catheter-associated bloodstream infections. If there is a contraindication to chlorhexidine, tincture of iodine, an iodophor, or 70 percent alcohol can be used as alternatives [75].

Use of chlorhexidine for routine intensive care unit (ICU) bathing (rather than soap and water) may also be an effective strategy to decrease the rate of bloodstream infection. (See 'Chlorhexidine bathing' below.)

Sterile technique — Attention to sterile technique is important for minimizing catheter-associated infection. This includes strict adherence to hand washing and aseptic technique and, with central venous catheter (CVC) insertion, sterile gloves, long-sleeved surgical gown, a surgical mask, and a large sterile sheet drape [3,33,76,77]. However, a 2006 report of intensive care units in 10 academic tertiary-care hospitals found that less than 30 percent had adopted maximal barrier precautions [78].

The following observations illustrate the importance of different components of this regimen.

●The effectiveness of educating clinicians in-training on infection control practices and procedures was evaluated in a nonrandomized pre-post observational trial of insertion of CVCs [79]. Six months after a one-day course, the perceived need for and documented use of full-size sterile drapes increased from 22 to 73 percent and from 44 to 65 percent, respectively, while the rate of catheter-associated bloodstream infections decreased from 3.3 to 2.4 per 1000 central line days.

http://www.uptodate.com/contents/prevention-of-intravascular-catheter-related-infections?source=machineLearning&search=permcath+care&selectedTitle=1~150&sectionRank=2&anchor=H25#H17

[IVRUS, BSN, RN]

When a "clinician" or anyone tells you something "outside" of the norm, make them prove it to you with the research/documentation. The burden of proof is on them to provide the information which they say is now appropriate.

[paolo962000]

It is the standard to use the CDC guideline in dressing the HD access. For us, we change the Sterile Gauze Dressing every 48h, and those with chlorhexidine ones once weekly (7 days).

[idialyze, BSN, RN]

At my clinic we use Alcavis to clean and soak connections and Except for site care. We have a small pt census, but haven't had a catheter infection in 4 years.

Anyone else use this technique, what are your infection rates?