592 - Impact of Polyhexamethylene Biguanide (PHMB) disc dressings on Central Line Associated Blood Stream Infection (CLABSI) in NICU

Publication Number: 592.5236

Tejasvi Chaudhari, Canberra Hospital, Yarralumla, Australian Capital Territory, Australia; Nadia Schmidt, Canberra Health Services, Curtin, Australian Capital Territory, Australia; Margaret Broom, University of Canberra, Canberra, Australian Capital Territory, Australia

Background: CLABSI (Central Line-Associated Bloodstream Infection) is a significant cause of mortality and morbidity in neonates. In most cases, the catheter insertion site becomes the entry point for organisms, which may originate from the patient’s own skin flora or result from contamination during the insertion process. Research has shown that chlorhexidine (CHG)-impregnated dressings at insertion sites can reduce bacterial colonization and the incidence of CLABSI in older populations (Ullman et al., Cochrane 2015). However, a similar review in neonates (Lai et al., Cochrane 2017) found that while CHG effectively reduced bacterial colonization, it also led to an increase in dermatitis. Polyhexamethylene biguanide (PHMB) is a broad-spectrum antimicrobial agent that is structurally similar to chlorhexidine but associated with fewer adverse skin effects. Initial feasibility studies have demonstrated good efficacy and safety of PHMB when used as discs at insertion sites in adults (Webster et al., Journal Hosp Infect, 2017; Pearse et al., Australian Critical Care, 2021). However, there is currently no data on the use of PHMB in neonates.

Objective: We aim to study the efficacy and safety of PHMB discs in our unit, reducing our baseline CLABSI rates from 6.7 per 1,000 central line days to below 3 per 1,000 central line days during the study period.

Design/Methods: Following ethics approval (2021/ETH11860), trial was commenced in April 2021 and continued till December 2022. PHMB disc was applied directly over insertion site during sterile PICC insertion and covered with usual dressing. PICC dressing was changed every 7 days along with the disc. CLABSI and central line days were monitored using a neonatal (NICUS) database and reviewed at 3 quarterly neonatal morbidity meetings. Skin integrity was reviewed through CLABSI maintenance bundle and reported through hospital risk management system (RISKMAN).

Results: CLABSI rates were reduced to 1.1/1000 CL days during the study period. There were no skin injuries/dermatitis reported from the discs. One baby had the PICC line inadvertently cut during a dressing change. PHMB discs are now a regular part of our central line bundle. We have been able to sustain a CLABSI rate of 2.4 per 1000 central line days until March 2024

Conclusion(s): PHMB discs are safe to use in neonates and can reduce CLABSI rates in NICU. Evidence-based central line bundles are still needed to reduce or eliminate CLABSI.

CLABSI Rates per 1000 Central Line Days
u-chart showing CLABSI rates/1000 Central Line days at The Canberra Hospital from Jan 2016 to March 2021 (pre-PHMB period) and April 2021 to December 2022 (post-PHMB period)

CLABSI Rates per 1000 Central Line Days
u-chart showing CLABSI rates/1000 Central Line days at The Canberra Hospital from Jan 2016 to March 2021 (pre-PHMB period) and April 2021 to March 2024 (post-PHMB period)