Application of

Chlorhexidine
Gluconate (CHG)
Impregnated
Dressing for Prevent
CLABSI
Ismail Prawoto
Juli 2022
 Central Line Associated Blood Stream Infection
 CLABSI (Catheter Line Associated Blood Stream Infection) / Infeksi Aliran Darah (IAD) : ditemukannya
organisme dari hasil kultur darah dengan disertai tanda klinis yang jelas serta tidak ada hubungannya
dengan infeksi ditempat lain, atau dokter yang merawat menyatakan telah terjadi infeksi
 Infeksi terjadi setelah pemasangan catheter intravaskuler >2×24 jam.

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 Patogenesis CLABSI

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 ALL vascular access devices = BSI risk
Central venous
catheters (CVC): Peripherally
Internal jugular, inserted central
subclavian, catheter (PICC)
femoral

Arterial line
catheter (ART)

Peripherally
inserted catheter
(PIV)

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 3M Health Care Academy
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Insiden HAIs pada pasien berisiko tinggi: 1995 - 2010

Tingkat Insiden HAIs di rumah sakit LMIC
2-4 kali lebih tinggi

Banyak negara di Wilayah Asia adalah LMIC

Low- to middle-income countries (LMIC)

High-income countries

World Health Organization 2011. Available at:

whqlibdoc.who.int/publications/2011/9789241501507_eng.pdf. Accessed
June 2015.
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Head Infection Prevention and Control: Today
Dibutuhkan tindakan untuk menurunkan HAI (CRBSI/ CLABSI) dan meningkatkan fokus
pelayanan pada patient outcomes
• CLABSI / CRBSI semakin dikenal sebagai HAI yang dapat dicegah
of them had a BSI

15,1
%
4,7%
ICU Patients
Total was Catheter related
51%
13.796 From:
Vincent JL 2009
International study
of the Prevalence
and Outcomes of
Infections in ICU.
JAMA vol. 302
nr 21
had infection

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Dampak terhadap Pasien
HAIs berkaitan atas sebagian besar kerugian pada pasien yang disebabkan oleh perawatan kesehatan 9

1.27 cases per 1000 Incidence rate estimated for hospitalized adult
device-days9 populations at risk for CLABSI.

1 in 4
1.57 times higher
CRBSIs are significant contributors to preventable
risk of mortality in hospital deaths.2
critically ill adults10

Patients who contract

12-24 more Real world evidence has demonstrated an increase in CLABSI die7
hospital resources - and associated cost - required to
hospitalization days treat morbidities due to CRBSIs11-15

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Head Infection Prevention and Control: Today
Dibutuhkan tindakan untuk menurunkan HAI (CRBSI/ CLABSI) dan meningkatkan fokus
pelayanan pada patient outcomes
• “Central venous catheter (CVC)–related bloodstream infections (BSIs) are associated with attributable mortality rates of up
to 11.5% and excess intensive care unit (ICU) stay lengths of up to 11 days”*

CR-BSIs ranges Cost of CR-BSI

Medical Costs Pharmaceutical costs Excess length of stay
unless preventative
measures are taken

1 TO 3.1 PER 1,000

CATHETER DAYS² £5,826³ £10,515⁴
*From: Soufir L et al. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted,
cohort study. Infect Control Hosp Epidemiol 1999;20:396–401. 2. Renaud B et al. Outcomes of primary and catheter-related bacteremia.
A cohort and case-control study in critically ill patients.Am J Respir Crit Care Med 2001;163:1584–1590.
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Update Guidelines
Transparent film dressing terintegrasi dengan Chlorhexidine direkomendasikan
untuk mencegah CLABSI

2015 2021
2017 2014

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Catether Site Dressing Regimens (CDC, 2017)

 Gunakan Chlorhexidine terimpreganted dressing dengan FDA
cleared untuk menutup area insersi CVC untuk menurunkan risiko
IADP (IA)
 Jika pasien diaphoresis atau area insersi bleeding gunakan kassa
sampai bleeding atau disphoresis berhenti (IA)
 Ganti dressing jika sudah kotor, tidak merekat, atau area insersi
tidak bisa terlihat (IB)
 Jangan gunakan antibiotic topical di area insersi (IB)
 Ganti dressing tiap 2 hari jika menggunakan kasaa (II) & tiap 7 hari
jika menggunakan transparent dressing
 Monitor area insersi saat mengganti dressing (IB)
 Edukasi pasien untuk melaporkan ketidak nyamanan di area insersi
kateter

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2021 INS Standar: Vascular Access Management
Skin Protection
Lindungi kulit yang berisiko dari
MARSI (Medical Adhesive Related
Skin Injury) dengan alcohol free barrier
film Std 42J.4B, hal. S120.17,19,23-25 ​
(II)
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Antimicrobial Dressings
Gunakan dressing yang mengandung
CHG untuk semua pasien - kecuali yang
berusia kurang dari 18 tahun, termasuk
neonatus prematur dengan CVAD non-
tunneled jangka pendek. (Standard 50)
Antimicrobial Port Protection
Lakukan desinfeksi passivedengan
disinfection caps untuk mencegah
kontaminasi diantara jeda penggunaan
line (Standard 36)
11
Perlindungan berbasis Antimikroba
Perlindungan area insersi yang berkelanjutan itu penting!

Skin Prep CHG hanya memberikan perlindungan selama 1-2 hari.1

Keberadaan chlorhexidine terus menerus di area insersi I.V. efektif dalam
menekan pertumbuhan kembali flora kulit selama beberapa hari 2,3
1. Safdar, N, Maki DG. The pathogenesis of catheter-
related bloodstream infection with noncuffed short-
term central venous catheters. Intensive Care Med.
Skin flora re-growth 2004;30:62-67.
2. Hendley, JO, Ashe KM. Effect of topical
comes back after 1-2 days antimicrobial treatment on aerobic bacteria
in the stratum corneum of human skin. Antimicrobial
Agents and Chemotherapy.
April 1991; 35(4)627-631.
3. Bashir, M.H. et al. Suppression of regrowth of
normal skin flora under chlorhexidine gluconate
dressings applied to chlorhexidine-prepped skin.

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Antimicrobial Protection - Evidence Based 3M Solution
Memberikan evidence based solution untuk mengurangi infeksi aliran darah

10
61% 60% £75 DAYS
Less skin and Less CR-BSI(2) Savings per patient if Continuous antimicrobial
catheter colonisation (2) used as recommended(3) protection(4)

• 3M Solution offers better protection against (1) NICE guidance 2015

catheter-related blood stream infections (CRBSIs),
and is more cost-effective compared to
sterile semipermeable transparent (standard) dressings (1)
• NICE Guidance and Epic3 include 3M solution for prevention of CRBSI
(2) Timsit, J.F.; et al. (2012): Randomised Controlled Trial of
Chlorhexidine Dressing and Highly Adhesive Dressing for
Prevention Catheter-related Infections in Critically III Adults;
American Journal of Respiratory and Critical Care Medicine, Vol.
186, No. 12: 1272–1278.
(3) NICE 2015 (From: Jeannes A. Reducing bloodstream infection
with a chlorhexidine gel IV dressing. British Journal of Nursing,
2015 (IV Therapy Supplement), Vol 24, No 19

(4) Karpanen TJ, et al. (2011) Antimicrobial activity of a

Chlorhexidine intravascular catheter site gel dressing, Journal of
Antimicrobial Chemotherapy, 66: 1777-1784.

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 Timsit (2012): CVC and Arterial Catheters21
Results:

CRBSI Rate (per 1000 catheter days) Catheter Colonization Incidence (per 1000
1.4
catheter days)
1.3
12

1.2
10.9
60% reduction 10
1 61% reduction
8
0.8

6
0.6
0.5 4.3
0.4
4
P <0.0001
P= 0.02
0.2 2

0 0
Non CHG dressing CHG dressing Non CHG Dressings CHG Dressings

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 3M™ Tegaderm™ CHG
I.V. Securement Dressing
Advanced Catheter Securement
Sterile Tape Strips • Reinforced stabilization border
• Precut for anchoring hubs, lumens • Catheter notch
and tubing
• Pattern coated film adhesive holds strongly,
manages moisture and releases gently
Breathable, Transparent Film
• Waterproof, sterile barrier to fluids and
Integrated CHG Gel Pad
bacteria*
• Can’t be forgotten
• Promotes moisture evaporation
• Conforms around catheter and hub for
• Conforms to body contours and flexes
complete coverage
with patient movement
• Remains clear even in the presence of
*In vitro testing shows that the transparent film provides a viral blood, saline and exudate
barrier from viruses 27 nm in diameter or larger while the dressing
remains intact without leakage.

Remember VASE: Visibility, Antimicrobial Protection, Securement, Ease of Use because it’s all integrated.
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CHG Gel: Tested against 37 microbial strains 17

Hensler JP, Schwab DL, Olson LK, Palka-Santini M. Growth inhibition of microorganisms involved in catheter-related infections by an antimicrobial transparent iv dressing containing chlorhexidine gluconate (CHG).
Presented at: 19th Annual Conference of the European Society of Clinical Microbiology and Infectious Diseases; May 16-19, 2009: Helsinki, Finland.

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3MTM TegadermTM
Chlorhexidine Gluconate
IV Securement Dressing
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3M™ Tegaderm™ CHG Dressing Science

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Thank you!

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