2.0 Background

Background

In 2011, CDC and HICPAC released Guidelines for the Prevention of Intravascular Catheter-Related Infections¹ that included two recommendations for C-I dressings:

• Use a chlorhexidine-impregnated sponge dressing for temporary short-term catheters in patients older than 2 months of age if the central line-associated bloodstream infection (CLABSI) rate is not decreasing despite adherence to basic prevention measures, including education and training, appropriate use of chlorhexidine for skin antisepsis, and maximal sterile barrier precautions (MSB)^12-14,16 (Category 1B: defined in 2011 as strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale; or an accepted practice [e.g., aseptic technique] supported by limited evidence).
• No recommendation is made for other types of chlorhexidine dressings (unresolved issue: defined in 2011 as represents an unresolved issue for which evidence is insufficient or no consensus regarding efficacy exists).

The 2011 recommendations were based on published evidence from the date of the first indexed article in the database through December 2009. The evidence consisted of randomized controlled trials (RCTs) and systematic reviews (SRs) that examined C-I sponge dressings, but not other types of C-I dressings. Between January 2010 and March 2017, new evidence accrued, including:

1. two RCTs that examined C-I sponge dressings⁸ or C-I gel dressings¹¹
2. two meta-analyses17,18 of these two types of C-I dressings evaluated as a single product class
3. a professional association's compendium of strategies for the prevention of CLABSI¹⁹ (CDC experts participated in the development of this document, which contains a section that evaluated two different C-I dressings as a single product class).