Ask an answerable question (PICO)：
Central line-associated bloodstream infection (CLABSI) is the first cause of health care-associated infection. It has been listed as one of annual patient safety goal in recent years. However, CVC bundle care has been implemented strictly, the bloodstream infection rate is unable to be zero. Studies results of the effectiveness of chlorhexidine gluconate (CHG) dressing in CLABSI prevention are inconsistent. The purpose of this study is to evaluate the effectiveness of CHG dressing in reducing the rate of CLABSI. The answerable question is: can CHG dressing reduce the central line-associated bloodstream infection of patients with indwelling central venous catheter?
The Method and Analysis of Literature Review：
Through Boolean logic, the study keywords and synonyms of PICO were searched on Cochrane library, Embase, PubMed and CEPS. Totally 344 literatures were obtained. After screening, one randomized controlled trial study and two systematic review with meta-analysis were selected. These three research evidences were critically appraised for validity, importance, and practicability through CASP and graded according to Oxford Center for Evidence-based Medicine 2011 Level of Evidence.
Critical Appraisal：
The CASP evaluates the validity, importance and practicability of these 3 studies. The evidence level were Level 1-2 according to the Oxford standard. The 3 studies were aimed at comparing the effectiveness of CHG dressing to other dressings on CLABSI prevention. But the conclusions were inconsistent. The first study is believed that CGI impregnated dressing can reduce the bloodstream infection rate (p=.022), and the second study also agrees that CHG dressing can reduce bloodstream infection rate (p = .004). The third study indicates that there is not enough evidence to show that CHG dressing is more effective in preventing bloodstream infection than OP site (p=1.00).
Clinical Application of Evidence：
The study was a project to improve the problems through evidence-based steps at a transplant center. Patients in this center with indwelling central venous catheter after liver transplantation were recruited into the study from April 2018 to August 2019. The subjects were divided into two groups. During the intervention, the central venous catheter wound care was dressed with the CHG dressing instead of OP site.
Evaluation of Effectiveness：
From October 2018 to March 2019, the rate of CLABSI after application of CHG dressing decreased from 7.58‰ to 2.83‰, a decline rate of 63%. What’s more, the bloodstream infection rate was zero during the maintenance period from April to August 2019.
Conclusions and Recommendations：
After using CHG dressing, we found that it can effectively reduce the rate of CLABSI, the medical costs, and the frequency of changing wound dressing. The result can provide a reference for medical institutions. It is also recommended to incorporate CHG dressing into the CVC care bundle, and it is expected that the goal of zero-tolerance will eventually be achieved.
