Central venous catheters (CVC) inserted and PICCO and hemodialysis catheters are widely used in patients for treatment and hemodynamic monitoring in China and worldwide. Catheter-Related Blood Stream Infections (CRBSI) pose a serious risk for already compromised patient population, where it is estimated that 3-5% of catheter-related procedures will result in CRBSI1 (Moureau et al, 2009). In order to continue to reduce CRBSI, the use of chlorhexidine impregnated dressings is recommended by WHO, NICE and the CDC. Clinical efficacy, demonstrated by a reduction in catheter related bloodstream infections and/or central line associated bloodstream infections has been demonstrated in multiple clinical trials2,3,4. Multiple studies have demonstrated that Tegaderm CHG dressing is intuitive to use and carries no greater risk of adverse skin reactions that existing comparable products5-9. The NICE guidance committee concluded that the Tegaderm CHG Dressing demonstrated cost-effective benefits while offering significantly improved CRBSI protection, as compared to non-chlorhexidine dressings.~The patient's own skin flora is the most dangerous source of infecting agent. CVCs may become colonized via migration of microorganisms from the CVC insertion site down the external catheter surface, during manipulation of catheter hubs, hematogenous seeding from another site of infection, or contaminated infusates10,11. CHG impregnated securement dressing maintains low skin organism count while dressing is in place. While CHG has been long used as a skin disinfectant and antiseptic, challenges arise as the skin's microflora begins to regrow mere hours post disinfection. A study12 demonstrated that Tegaderm CHG dressing significantly reduced the number of microorganisms at the CVC insertion and suture sites with concomitant reduced catheter colonization.~Although many studies demonstrated clinical efficacy in reduction of skin colonization and catheter colonization, as far as we know, few studies have been reported on the clinical performance of Tegaderm CHG dressing application in China. A China study reported that the incidence of ICU-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) catheter related colonization/infection was 10.08 per 1000 ICU patient-days13. China KOLs insist on a local study to demonstrate the clinical benefit of Tegaderm CHG dressing in China due to the local-based clinical practice and treatment environments. Only with the substantiation of local evidence for Tegaderm CHG dressing in China, they would like to recommend it to be used in routine ward/nurse care.~Moreover, there is a significant demand to have a solid local evidence to prove the cost effectiveness of Tegaderm CHG dressing, which results to improving local care for critical illness.~So, this outside hospital study is proposed to develop local evidences for Tegaderm CHG dressing on bacteria colonization as 1st step to demonstrate the clinical value in China. This study will help to develop and maintain KOL and ICUs relationship as well. And the generated evidence in China may help for requirement of certificate renewal.
It's to investigate the difference of the number of microorganisms at the DVC insertion site and catheter tip after catheter removal both in Tegaderm CHG dressing group and Tegaderm standard dressing group. The objective of this study is to evaluate the antimicrobial efficacy and safety observation in skin condition of Tegaderm CHG dressing on DVC insertion site in adult patients in critical care comparing with Tegaderm Standard Dressing.