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Reduction of external ventricular drain associated infections after introduction of a chlorhexidine containing dressing
EANS Academy. Röthlisberger M. Sep 27, 2019; 275995; EP12057
Dr. Michel Röthlisberger
Dr. Michel Röthlisberger

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Abstract
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Background: Dressings containing chlorhexidine (CHX) lower the incidence of external ventricular drain (EVD)-associated infections (EVDAIs). In a previous prospective randomized trial (RCT) at the University Hospital Basel (NCT02078830), a significant reduction in bacterial cutaneous and catheter colonization was detected. However, the study was underpowered to demonstrate an effect on the incidence of EVDAI.
Methods: Retrospective (2009-2013) and prospective (2014-2017) review of patients undergoing EVD-insertion at the University Hospital Basel. The control group consisted of patients from January 2009 to October 2013, where the CHX-dressings were not in use. The study group consisted of patients between February 2016 and December 2017, where CHX-dressing was standard of care. Comparisons were made using the Chi-squared test. Primary endpoint was the diagnosis of EVDAI. Statistical significance was set at P ≤ .05.
Results: 224 out of 306 (73.2%) patients were eligible for analysis. 79 out of 224 (35.3%) were assigned to the control group, 55 out of 224 (24.6%) to the RCT-group and 90 out of 224 (40.2%) to the study group. During the whole study period, 118 out of 224 (52.7%) received a CHX-dressing while 106 out of 224 (47.3%) did not. The rate of EVDAI were substantially lower after the introduction of the CHX-dressing but did not reach significance (p=.083). However, 11 out of 118 (9.3%) in the CHX- compared to 20 out of 106 (18.9%) in the Non-CHX-group developed EVDAI (p=.039).


  Before introduction of CHX-dressing EVDAI-RCT (NCT02078830) After introduction of CHX-dressing Total
Time Period Jan 2009 to Oct 2013 Oct 2013 to Jan 2016 Feb 2016 and Dec 2017  
EVDAI 13 (16.4%) 11 (20%) 7 (7.8%) 31 (13.8%)
No EVDAI 66 (83.6%) 44 (80%) 83 (92.2%) 193 (86.2%)
Total 79 (100%) 55 (100%) 90 (100%) 224 (100%)
[Table 1: Infection rates before, during and after the introduction of CHX-containing dressings as a standard of care for the exit site of EVD]


Conclusion: CHX-containing dressings as a standard of care for the exit site of EVD effectively reduce the incidence of EVDAI.
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