673. Non-Inferiority of a Novel Silver-Impregnated Dressing for Central Venous Catheters: A Retrospective Cohort Evaluating Rates of Central Line-Associated Bloodstream Infections in Adult Intensive Care Patients
Session: Poster Abstract Session: Preventing Catheter Associated Infections
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • CLABSI for IDSA 9.27.11.pdf (293.2 kB)
  • Background: Annually in the United States there are over 80,000 central line associated bloodstream infections (CLABSIs).  The cost of a single CLABSI is estimated at greater than $30,000 and 9 additional days of hospital care.  Use of chlorhexidine gluconate-impregnated sponge (CHGIS) dressings for central venous catheters (CVC) has been associated with reduced rate of CLABSIs.  However, there are few studies evaluating non-CHGIS dressings for CVCs.

    Objective: The objective of this cohort study is to assess the non-inferiority of novel silver-impregnated CVC dressings in comparison to chlorhexidine gluconate-impregnated dressings in preventing CLABSIs in adult ICU patients.

    Methods: Approximately 3,500 patient charts are included in this retrospective cohort study of all adult patients receiving a CVC in seven different ICUs from 01/2009 - 12/2010.  All patients receiving a CVC before June 1, 2009 received a CHGIS.  All lines inserted after June 1, 2009 were dressed with the novel SID.  All CVC dressings were covered by a transparent adherent sticker.  The main outcome measures recorded include rates of CLABSI per 1,000 catheter-days and length of stay in the ICU. 

    Results:  In total, there were 44,465 catheter-days with CHGIS dressings and 45,981 catheter-days with SID dressings.  There was no interaction between the interventions.  Initial basic demographic data has been equal between the groups.  There was a statistically significant decrease in the rate of CLABSI in the SID group, see Table 1.  The absolute risk reduction realized from SID was 0.07.  The relative risk (RR) of CLABSI in the SID group was 0.53 (95% CI 0.36-0.78, p = 0.001).  The length of stay was not significantly different between the groups.

    Table 1: Results of CVCs dressed with CHGIS and SID

     

    CHGIS

    SID

     

    Rate of CLABSI

    per 1,000 catheter days

    1.64 (n = 73/44,465)

    0.87 ( n = 40/45,981)

    95% CI 0.36-0.78

     p = 0.001

     

     

     

     

    Mean Length of Stay ± SD

    Days in ICU

    13.1 ± 29.5

    12.6 ± 15.8

     p = 0.848

    Conclusion: The novel silver-impregnated disk dressings are not inferior to chlorhexidine gluconate-impregnated sponge dressings for prevention of CLABSIs.  If SID are used on all catheters, the decreased rate of CLABSI observed would calculate to a cost savings of $23,100 per 1000 catheter-days.


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Asa Oxner, MD1,2, Andrew Myers, MD1,3, John Sinnott, MD, FACP1, Jillian Sajdak4, Peggy Thompson, RN, BSN4 and Charles Myers1, (1)International Affairs and Infectious Diseases, University of South Florida, Tampa, FL, (2)Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, (3)Internal Medicine, The George Washingon University Hospital, Washington, DC, DC, (4)Infection Prevention/Vascular Access, Tampa General Hospital, Tampa, FL

    Disclosures:

    A. Oxner, None

    A. Myers, None

    J. Sinnott, None

    J. Sajdak, None

    P. Thompson, None

    C. Myers, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.