Effective interventions with chlorhexidine gluconate (CHG) to decrease hemodialysis (HD) tunneled catheter‐related infections

Purpose:  Identify practices to reduce HD catheter access related bacteremias (ARB). Methods:  Data was collected per the CDC Dialysis Surveillance Network protocol. ARB was defined as a patient with a positive blood culture with no apparent source other than the vascular access catheter. ARB's were calculated in events per 100 patient months with 3 cohorts. Cohort 1 was observed for 12 months, Cohort 2 for the subsequent 10 months, and Cohort 3 for the final 10 months. Cohort 1 had weekly transparent dressing changes, cleansing of the skin and 5 minute soaking of the connection lines with 10% povidone‐iodine (PI) solution, and HCW use of clean gloves and face shield without a mask. Cohort 2 changes consisted of thrice weekly gauze dressing changes, skin cleansing with ChloraPrep, a 2% CHG/70% isopropyl alcohol applicator, masks on the patients, adding a face mask to the shield, and application of 10% PI ointment to the exit site. Cohort 3 changes included weekly application of BioPatch (BioP), an antimicrobial dressing with CHG, sterile glove use, and replacing the PI line soaks with 4% CHG. Results:  The catheter‐associated ARB rate per 100 patient months was 7.9 (17ARB/216 patient months) in Cohort 1 , 8.6 (13/151) in Cohort 2 , and 4.7 (5/107) in Cohort 3 (p = 0.31 compared with Cohorts 1 and 2 combined). During the last 2 months, in Cohort 3 , 9 catheter lumen cracks occurred, with one of the patients having a bacteremia. Conclusions:  Addition of CHG line soaks and BioP reduced tunneled catheter infections, although this is not statistically significant. The increased number of catheter lumen cracks raises concern with the use of CHG line soaks. Further investigation with use of CHG line soaks and the BioP for decreasing ARB is needed.