Antimicrobial-Impregnated Discs for Prevention of Intravenous Catheter-Related Infections

Problem statement: Healthcare-associated infections are the 5th leading cause of death in the United States. Catheter-Related Bloodstream Infections (CRBSIs) comprise 14% of all healthcare-associated infections and contribute to increased mortality and financial costs. Antimicrobial-impregnated sponge discs to be used surrounding the catheter insertion site are a newer addition to the options available for the prevention of catheter-related infections. Approach: This review critically appraises the literature regarding the utility of antimicrobial-impregnated discs. We performed a literature search using the MEDLINE (1948-November 2011) database. Only controlled clinical trials were included and the electronic database search was performed using the following MeSH and keyword search terms: (“Biopatch” or “chlorhexidine”) and (“dressing” or “sponge”) and (“catheter”). Results: Our search yielded eight trials. Chlorhexidine-impregnated discs are effective in preventing catheter colonization in hospitalized patients and outpatients; however, effectiveness in preventing CRBSIs may be limited to hospitalized, critically ill patients. Although many studies have evaluated the effectiveness of several pharmaceutical agents for the prevention of catheter-related infections, there are still significant gaps in the literature regarding these infections, including the effectiveness of Polyhexamethylene Biguanide (PHMB)-impregnated discs and the cost-effectiveness of PHMB-impregnated discs compared to chlorhexidine-impregnated discs. It is also unclear if antimicrobial-impregnated discs are effective in specific populations, like in outpatients, patients at high risk compared to low risk patients and patients with long-term catheters. Conclusion: Chlorhexidine-impregnated discs should be utilized for the duration of catheterization in high risk, critically ill patients and in hospitals where catheter-related infection rates are persistently high despite other preventative strategies. Futher investigation of the effectiveness of these discs in other populations and of other antimicrobial-impregnated discs is needed.