Infection in Acute Dialysis Patients with Central Venous Catheters

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Table of Contents

Introduction
The Review
Conclusion
References

Introduction

A literature review is a type of scholarly paper. Its main purpose is to summarize and analyze a number of articles, books, research papers dedicated to a specific topic with the goal of getting an understanding of it. This paper will provide a brief literature review of a number of articles on Infection in acute dialysis patients with central venous catheters.

The Review

Five distinct articles from various scholarly publications were chosen for this review. The majority of the articles were done by large teams of researchers with the purpose of providing a substantiated result that could be used to change the current medical practice. The topic of catheter-related bloodstream infections is highly relevant as they are associated with significant morbidity and mortality (Safdar et al., 2014). The presented articles offer possible solutions to this issue.

The earliest presented paper was published in 2001 and consisted of a randomized trial that compared povidone-iodine to a chlorhexidine gluconate-impregnated dressing as prevention methods against this type of infection. The researchers found that the chlorhexidine-impregnated dressing, when replaced weekly, was as effective as cutaneous disinfection. However, despite the effectiveness of the solution, the risk of local contact dermatitis when using chlorhexidine dressing prevents its use in low birth weight infants during their first two weeks of life (Garland et al., 2001).

Another inconclusive paper on the use of chlorhexidine antiseptic solution instead of an alcohol-based povidone-iodine solution was published in 2012. The research for the paper was conducted in a critical care unit. Despite the two-year-long periods of routine surveillance, no significant benefits to the use of chlorhexidine antiseptic solution were noted, and no cost advantage over the povidone-iodine solution was recorded. It is possible that the number of examined cases was limiting the study (Girard, Comby & Jacques, 2012).

The next examined paper was published by Leonard Mermel, and it focused on the predominant source of intervascular catheter infections. The author examines a variety of possible sources and concludes that both extraluminal and intraluminal routes of infection have to be considered when examining the issue of venous catheter-related infections. The author prioritizes catheter insertion and maintenance as possible precautions against both short term and long term infections. He notes that novel solutions should be implemented to reduce the risk of infections, such as antimicrobial dressings and catheter flush solutions (Mermel, 2010).

This sentiment is supported by a paper from 2015 on the use of chlorhexidine-alcohol for the prevention of intravascular catheter-related infections. Unlike the research paper from 2012, this group assembled 2547 patients and separated them into two large groups. The study compared chlorhexidine-alcohol solution against povidone iodine-alcohol for skin antisepsis. The research found that chlorhexidine-alcohol solution provided greater protection against short-term catheter-related infections and recommended that it should be included in all bundles for prevention of these types of infections (Mimoz et al., 2015).

A meta-analysis, from a year prior, found similar results. It focused on assessing the efficacy of a chlorhexidine-impregnated dressing for prevention of catheter-related infections. By examining nine randomized controlled trials, the research team found that the use of chlorhexidine-impregnated dressing is both beneficial in catheter colonization prevention and catheter-related infections. The research group recommends the use of this solution in patients at risk of infection and colonization (Safdar et al., 2014).

Conclusion

The examined body of knowledge reveals that chlorhexidine-alcohol based solutions could be beneficial as novel preventative measures for catheter-related infections and colonization. Despite the early reports of insignificant benefits, current information suggests that this method should be implemented for patients at risk of these types of infections.

References

Garland, J., Alex, C., Mueller, C., Otten, D., Shivpuri, C., Harris, M., … Maki, G. (2001). A randomized trial comparing povidone-Iodine to a chlorhexidine gluconate-impregnated dressing for prevention of central venous catheter infections in neonates. PEDIATRICS, 107(6), 1431-1436.

Girard, R., Comby, C., & Jacques, D. (2012). Alcoholic povidone-iodine or chlorhexidine-based antiseptic for the prevention of central venous catheter-related infections: In-use comparison. Journal of Infection and Public Health, 5(1), 35-42.

Mermel, L. (2010). What is the predominant source of intravascular catheter infections?. Clinical Infectious Diseases, 52(2), 211-212.

Mimoz, O., Lucet, J., Kerforne, T., Pascal, J., Souweine, B., Goudet, V., … Timsit J. (2015). Skin antisepsis with chlorhexidine–alcohol versus povidone iodine–alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. The Lancet, 386(10008), 2069-2077.

Safdar, N., O’Horo, J., Ghufran, A., Bearden, A., Didier, M., Chateau, D., & Maki, D. (2014). Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection. Critical Care Medicine, 42(7), 1703-1713.

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Infection in Acute Dialysis Patients with Central Venous Catheters

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