Ask an answerable question (PICO)：
In the care of patients with central venous catheters, use standard polyurethane dressings to cover. The purpose is to establish a physical safety barrier to reduce the chance of bacterial invasion, mainly to prevent catheter-related bloodstream infection (Central Line-associated Bloodstream Infection, CLABSI). Fixed function to prevent slippage of the catheter, prevent skin allergies and prevent skin flora. The clinical market has introduced CHG antibacterial dressings (chlorhexidine gluconate, CHG) that can reduce skin flora (Staphylococcus Epidermidis or Staphylococcus Aureus) infection. This antibacterial dressing containing CHG can be purchased from medical equipment stores in the market. Nursing staff often face whether patients or family members need to purchase this antibacterial dressing to help reduce the occurrence of infections. In view of this, we intend to use methods of evidenced-based to understand the comparison of CLABSI infection rates between CHG antibacterial dressings and standard polyurethane dressings (OP site).
The Method and Analysis of Literature Review：
PICO is formed from situational clinical questions, using the main keyword: [P] central venous catheters.【I】chlorhexidine gluconate-impregnated dressings. [C] Polyurethane dressings. [O] Central line-associated bloodstream infection. The search strategy with "or", "and" and brackets in series, using PubMed, Cochrane Library, EMBASE and other databases, regardless of year and language. A total of 76 articles in English were obtained. Priority is given to the screening of Systematic Reviews and randomized trials. Finally, 1 Systematic Reviews (2015) and 1 RCT (2019) with higher evidence levels are used for evaluation.
Critical Appraisal：
Among the two articles reviewed, Systematic Reviews (2015) used the CASP and Oxford research evidence to use grade classification to evaluate the level of evidence as Level 1 (Therapeutic type); and 1 RCT used Cochrane (2016) RoB 2.0 to evaluate the quality of the literature It is low risk of bias (L). The subjects of the study were patients who received central venous catheters and were older than 18 years of age. The interventional measures included CHG antibacterial dressings in catheter care; the control group received polyurethane dressings. Results Comparing the catheter-related bloodstream infection rates of the two dressings, there was no significant difference in the results of the integrated analysis of the SR study (Z=1.78, P=0.08, RR 0.65, 95%CI: 0.40-1.05), and there was no difference between the two groups in the RCT study. (P=1.00), showing that compared with polyurethane dressings, the use of CHG-containing antibacterial dressings does not have a significantly lower catheter-related bloodstream infection rate.
Results, Conclusions and Recommendations：
The patients of central venous catheters that compared with the use of general waterproof and breathable dressings, 27 people have bloodstream infections per 1,000 people. However, 16 people out of every 1,000 people who used CHG antibacterial dressings had bloodstream infections, and there was no significant statistical difference between the two. Based on this empirical literature search, there is not enough evidence to support which dressings can effectively reduce catheter-related bloodstream infections. In the future, more rigorous randomized trials are needed to control random allocation and concealed allocation and provide clinical reference.
