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July 22 2009

Chlorhexidine-Impregnated Sponges and Prevention of Catheter-Related Infections—Reply

JAMA. 2009;302(4):379-380. doi:10.1001/jama.2009.1036

In Reply: Dr Lv and colleagues address the potential danger of extending the dressing changes to 7 days in particular subpopulations with a higher risk of catheter colonization.1 The risk of catheter colonization did not significantly differ between 3-day and 7-day dressing changes in surgical patients (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.72-1.57) or in immunocompromised patients (HR, 0.91; 95% CI, 0.26-3.21). Results were also similar for femoral catheter only (HR, 1.40; 95% CI, 0.97-2.02), jugular catheter only (HR, 0.74; 95% CI, 0.45-1.21), subclavian catheter only (HR, 1.19; 95% CI, 0.62-2.27), and radial catheter only (HR, 0.93; 95% CI, 0.56-1.53). Blood cultures were not collected at the time of catheter insertion. The rate of dressing change was not different between the CHGIS and control groups (P = .10). The sponge may absorb secretion and increase dressing adhesion, but it should not play a major role in the CHGIS efficacy. Finally, we agree that a thorough cost-effectiveness study, including all possible costs (such as cost of treating contact dermatitis) is needed to better define the place of CHGIS in the prevention of CRI. This analysis is ongoing.

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