A peek at the ‘no-dressing’ technique
A peek at the no-dressing’ technique
It may have a place in certain situations
Following a high rate of exit site infections in patients, the Immunodeficiency Clinic at the Toronto Hospital began evaluating the use of no dressing on HIV patients with percutaneous central venous catheters.
Before, the hospital initially changed a transparent dressing weekly. However, patients complained of itching and burning under the dressing, dressing adherence, and not being able to shower. After reviewing certain literature and finding documented evidence of a higher incidence of infection rates when using transparent dressings compared to gauze dressings in medical, surgical, and pediatric patients with central venous catheters both plastic and silicone.
As a result of the literature, the hospital followed a group of HIV patients who had central venous catheters inserted for long term intravenous treatment of cytomegalovirus retinitis from April 30, 1993, to April 30, 1994.
This is only a test
In the study, a gauze dressing was used and changed three times over the first week, after which the line was left uncovered. Patients received their therapy through the hospital’s medical day unit, coming to the unit once each week for blood work and line assessment.
The "no-dressing" patients were permitted to shower daily, using soap and water to cleanse around the exit site, beginning one week after insertion. An additional 15 patients had central venous catheters inserted over the same time and were cared for by the home care program’s visiting nurses. Home care patients were assessed once weekly to twice daily, with the home care program’s protocol consisting of transparent dressings on all central venous catheters with weekly change.
For study purposes, a culture swab was deemed positive if it had a moderate to high growth of S. aureus or other potential pathogen as these were the only patients who received treatment. The no dressing group had a 15.7% local infection rate, consisting of three patients: one positive for K. pneumoniae and two for S. aureus. The home care group had a 20% local infection rate with three positive exit-site swabs: All three exhibited heavy growth of S. aureus.
The hospital concluded there was no increase in exit site infection rates for central lines in patients without dressings when compared to lines covered with a transparent dressing. Benefits of no dressing consist of considerable cost savings, as well as time saved by the nurse and home patient who is not required to do dressing changes. The hospital has not done a randomized control trial to confirm its observations.
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