Catheter-related bloodstream infections are associated with increased mortality, morbidity, and length of hospital stay. The incidence has decreased significantly with the strict implementation of preventive bundle cares and checklists in intensive care units. Bathing with solutions containing chlorhexidine has been included in preventive strategies in recent years. Although some studies have shown that chlorhexidine bathing reduces the frequency of hospital-associated infections, there are important differences in management of practice and adherence to practice in different facilities. The majority of the studies conducted include adult patients. According to the CDC guidelines, chlorhexidine bathing is recommended for children over 2 months of age to prevent catheter-related bloodstream infection. The aim of this study is to investigate the effect of daily bathing with 2% chlorhexidine gluconate solution in preventing catheter-related bloodstream infections in pediatric patients with temporary central venous catheters.
In patients with a central catheter for longer than 48 hours, the diagnosis of bloodstream infection will be recorded as laboratory-confirmed bloodstream infections according to CDC diagnostic criteria. Microorganisms detected in cultures will be classified as gram-positive and gram-negative or fungal agents. Infection with the resistant microorganism will be compared with the control group. Catheter colonization; be defined as bacterial growth of more than 15 colonies in the semiquantitative culture or 1000 colonies in the quantitative culture of the catheter segment or hub without clinical symptoms. Patients in both groups with a central catheter for longer than 48 hours will be treated with a standard bath every 72 hours. In addition to the control group, patients in the study group will be treated daily with 2% chlorhexidine gluconate, and the patients in these two groups will be compared in terms of catheter-related bloodstream infections and catheter colonization.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
200
daily skin cleansing with chlorhexidine gluconate
IMU
Istanbul, Kadıköy, Turkey (Türkiye)
RECRUITINGCatheter-related blood stream infection rates
In patients with a central catheter for longer than 48 hours, the diagnosis of bloodstream infection will be recorded as laboratory-confirmed bloodstream infections according to CDC diagnostic criteria. Microorganisms detected in cultures will be classified as gram-positive and gram-negative or fungal agents. Infection with the resistant microorganism will be compared with the control group.
Time frame: 2 years.
Catheter colonization rates
Catheter colonization; be defined as bacterial growth of more than 15 colonies in the semiquantitative culture or 1000 colonies in the quantitative culture of the catheter segment or hub without clinical symptoms.
Time frame: 2 years.
Demographic features of participants
The investigators will be evaluating the features below: * Age of the patients (months) * Sex of patients * Weight of patients (kilograms) * Height of patiens (centimeters)
Time frame: 2 years.
Comorbidities of participants
The investigators will be evaluating the comorbidities in each groups, in order to determine if any of these conditions would interfere with infection rates.
Time frame: 2 years.
Catheter site of placement
It will be classified as; femoral, internal jugular, subclavian.
Time frame: 2 years.
The duration of intensive care unit stay for each participants
It will be evaluated as days.
Time frame: 2 years.
Duration of catheter usage
It will be evaluated as the total amount of time as days.
Time frame: 2 years.
Number of catheter lumens
It will be evaluated wether it has 2 or 3 lumens.
Time frame: 2 years.
Time when catheter is started the use
It will be noted that the time of intensive care hospitalization that catheter usage started. It will be evaluated as days.
Time frame: 2 years.
Number of catheter dressing changes
It will be evaluated that the amount of planned or unplanned changes of catheter dressing.
Time frame: 2 years.
Reason for the catheter removal
It will be classified as for example; infection, dysfunction, lack of need...
Time frame: 2 years.
The reason of intensive care hospitalization for each participants
It will be evaluated that the primary reason that cause for patient to need for intensive care.
Time frame: 2 years.
PRISM (pediatric risk of mortality) score of the participants
The Pediatric Risk of Mortality (PRISM) score was developed from the Physiologic Stability Index (PSI) to reduce the number of physiologic variables required for pediatric ICU (PICU) mortality risk assessment and to obtain an objective weighting of the remaining variables.
Time frame: 2 years.
Need for invasive mechanical ventilation support
It will be evaluated if the patient needed for invasive mechanical ventilation support or not. If so, how many days is it required will be noted.
Time frame: 2 years.
Need for hemodialysis catheter usage
It will be noted that wether the patient has hemodialysis catheter or not.
Time frame: 2 years.
Presence of parenteral steroid use
It will be noted that if during the intensive unit care, wether patient need pulse steroid treatment (30milligram/kilogram/day for 3 or more days) or treatment with Prednisolone 2 milligram/kilogram/day or more for 14 or more days
Time frame: 2 years.
Rate of catheter-related bloodstream infection in patients bathing with 2% chlorhexidine gluconate daily.
Incidence will be determined by dividing the number of patients who had catheter-related bloodstream infections in patients who underwent daily skin cleansing with chlorhexidine, compared to the total number of patients who underwent daily skin cleansing with chlorhexidine. Patients who were treated with a standard bath and those treated with a chlorhexidine bath will be compared.
Time frame: Through study completion, 2 years.
Rate of catheter colonization in patients bathing with 2% chlorhexidine gluconate daily.
Incidence will be determined by dividing the number of patients who had catheter colonization in patients who underwent daily skin cleansing with chlorhexidine, compared to the total number of patients who underwent daily skin cleansing with chlorhexidine. Patients who were treated with a standard bath and those treated with a chlorhexidine bath will be compared.
Time frame: 2 years.
Microorganisms that grown in cultures of catheter-related bloodstream infection in patients bathing with 2% chlorhexidine gluconate daily.
It will be noted which microorganisms grown in the cultures. By classifying microorganisms grown in culture (gram positive, gram negative, fungal infections, etc.), a comparison will be made between the two groups in terms of incidence.
Time frame: 2 years.
Microorganisms that cause catheter colonization in patients bathing with 2% chlorhexidine gluconate daily.
It will also be noted which microorganisms grown in the cultures. By classifying microorganisms grown in culture (gram positive, gram negative, fungal infections, etc.), a comparison will be made between the two groups in terms of incidence.
Time frame: 2 years.
Rate of catheter-related bloodstream infection in patients who applied standard bathing
Incidence will be determined by dividing the number of patients who had catheter-related bloodstream infection in patients who underwent standard bathing to the total number of patients who underwent standard bathing. Patients who were treated with a standard bath and those treated with a chlorhexidine bath will be compared.
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Time frame: 2 years
Rate of catheter colonizsation in patients who applied standard bathing
Incidence will be determined by dividing the number of patients who had catheter colonization in patients who underwent standard bathing to the total number of patients who underwent standard bathing. Patients who were treated with a standard bath and those treated with a chlorhexidine bath will be compared.
Time frame: 2 years
Microorganisms that grown in cultures of catheter-related bloodstream infection in patients which applied standard bathing
It will also be noted which microorganisms grown in the cultures. By classifying microorganisms grown in culture (gram positive, gram negative, fungal infections, etc.), a comparison will be made between the two groups in terms of incidence.
Time frame: 2 years.
Microorganisms that cause catheter colonization in patients which applied standard bathing
It will also be noted which microorganisms grown in the cultures. By classifying microorganisms grown in culture (gram positive, gram negative, fungal infections, etc.), a comparison will be made between the two groups in terms of incidence.
Time frame: 2 years.