Drug-Coated Sponges May Limit Catheter Infections

More than 10% of ICU patients are thought to develop these infections

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HealthDay Reporter

TUESDAY, March 24, 2009 (HealthDay News) -- Adding a sponge soaked in an antibacterial agent to the dressing around the spot where a catheter is inserted appears to reduce the chances that a potentially deadly infection will develop, French researchers report.

People in intensive care units (ICUs) usually require insertion of a central venous catheter. In the United States, about 80,000 catheter-related infections occur each year among ICU patients, including those caused by MRSA bacteria (methicillin-resistant Staphylococcus aureus). The death rate from these infections can be as high as 11.5 percent, the researchers reported in the study.

"This is an important study," said Dr. Marc Siegel, an associate professor of medicine at New York University School of Medicine in New York City, who was not involved in the research. "The specific use of disinfectant in this way is important in preventing life-threatening infections" and has the potential to dramatically reduce the number of catheter-related infections, he said.

The report is published in the March 25 issue of the Journal of the American Medical Association.

For the study, the research team randomly assigned more than 1,600 ICU patients to have their catheters inserted with sponges soaked in chlorhexidine gluconate, an antibacterial commonly used in mouthwash, or to have standard dressings used on the insertion site. Dressings were changed every three to seven days.

They found that the rate of infections dropped from 1.1 percent among people who'd had standard dressings to 0.5 percent among those with an antibacterial-soaked dressing -- a 61 percent reduction. The researchers estimated that the chlorhexidine gluconate dressings prevented one major infection for every 117 catheters left in place for about 10 days.

Besides reducing infections, use of bacterial-soaked sponges also appeared to require less frequent changing of dressings, the researchers noted.

Bacteria was found on 7.8 percent of the catheters removed after three days, the study found, and on 8.6 percent of the catheters removed after seven days, for a difference of 0.8 percent.

They described this as a modest reduction that "appears safe."

However, one expert remained dubious as to the advisability of leaving dressings on for longer than the standard three days.

"What is extremely important here is that, while the infection rate did not increase with these less-frequent dressing changes, this finding applied only to unsoiled dressings," said Dr. Pascal James Imperato, dean of the graduate program in public health at the State University of New York Downstate Medical Center, New York City.

Because leakage and soiling are very common at catheter insertion sites, it wasn't surprising that the study found that the absolute decrease in dressing changes was modest, Imperato said.

"In other words, in most patients, the dressings need to be changed every three days -- if not more often -- because of leakage and soiling," he said. "Thus the findings of this study have limited practical application."

More information

The U.S. Centers for Disease Control and Prevention have more on protecting patients from infection.

SOURCES: Pascal James Imperato, M.D., M.P.H., dean, distinguished service professor, Graduate Program in Public Health, State University of New York Downstate Medical Center, New York City; Marc Siegel, M.D., associate professor of medicine, New York University School of Medicine, New York City; March 25, 2009, Journal of the American Medical Association

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