Document Type : Review Article

Authors

1 Department of Nursing, Najafabad Branch, Islamic Azad University, Najafabad, Isfahan, Iran

2 Department of Nursing, Nursing and Midwifery Sciences Development Research Center, Na.C., Islamic Azad University, Najafabad, Iran

3 School of medicine, Ahvaz Jondishapur University of Medical Sciences, Ahvaz, Iran

4 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: The significance of central line-associated bloodstream infection (CLABSI) is that it increases morbidity, mortality, and treatment costs. The incidence of infections is reduced by the use of antibiotic-impregnated dressings at the central catheter insertion site. In this context,  polyhexamethylene biguanide (PHMB)-containing dressings have been used instead of disinfectants like chlorhexidine gluconate and routine care in treating CLABSI. Therefore, the present comprehensive review of trials was conducted to examine the effect of PHMB on CLABSI.
Methods: The search was conducted using Google Scholar and databases like Medline, Cochrane Library, Science Direct, ISI Web of Science, Scopus, and ProQuest. The goal was to find English language randomized controlled trials (RCTs) according to PRISMA guidelines from October 2023 until April 2024.
Results: The available data obtained from three studies, which included 396 patients in the intervention group versus 400 patients in the control groups, suggest that PHMB is effective in reducing the CLABSI rate. Also, the dressing dwell time was not significantly different from the controls.
Conclusion: The results reviewed indicate that PHMB is effective in preventing CLABSI, and any reported complications can be managed or treated. Nevertheless, trials with larger sample sizes are recommended.
 

Keywords

Main Subjects

  1. Yu KC, Jung M, Ai C. Characteristics, costs, and outcomes associated with central-line-associated bloodstream infection and hospital-onset bacteremia and fungemia in US hospitals. Infect Control Hosp Epidemiol. 2023;44(12):1920-6. doi: 10.1017/ice.2023.132
  2. Kassaian N, Nematbakhsh S, Yazdani M, Rostami S, Nokhodian Z, Ataei B. Epidemiology of bloodstream infections and antimicrobial susceptibility pattern in ICU and non-ICU wards: a four-year retrospective study in Isfahan, Iran. Adv Biomed Res. 2023;12:106. doi: 10.4103/abr.abr_320_22
  3. Lutufyo TE, Qin W, Chen X. Central line associated bloodstream infection in adult intensive care unit population— changes in epidemiology, diagnosis, prevention, and addition of new technologies. Adv Infect Dis. 2022;12(2):252-80. doi: 10.4236/aid.2022.122022
  4. Wall JB, Divito SJ, Talbot SG. Chlorhexidine gluconate-impregnated central-line dressings and necrosis in complicated skin disorder patients. J Crit Care. 2014;29(6):1130.e1-4. doi: 10.1016/j.jcrc.2014.06.001
  5. Pearse I, Marsh N, Rickard CM, Ullman AJ, Larsen E, Pelecanos A, et al. Polyhexamethylene biguanide discs versus unmedicated dressings for prevention of central venous catheter-associated infection in the intensive care unit: a pilot randomised controlled trial to assess protocol safety and feasibility. Aust Crit Care. 2022;35(5):512-9. doi: 10.1016/j. aucc.2021.05.015
  6. Webster J, Larsen E, Marsh N, Choudhury A, Harris P, Rickard CM. Chlorhexidine gluconate or polyhexamethylene biguanide disc dressing to reduce the incidence of central-line-associated bloodstream infection: a feasibility randomized controlled trial (the CLABSI trial). J Hosp Infect. 2017;96(3):223-8. doi: 10.1016/j.jhin.2017.04.009
  7. Guiomar AJ, Urbano AM. Polyhexanide-releasing membranes for antimicrobial wound dressings: a critical review. Membranes (Basel). 2022;12(12):1281. doi: 10.3390/ membranes12121281
  8. Lee CK, Chua YP, Saw A. Antimicrobial gauze as a dressing reduces pin site infection: a randomized controlled trial. Clin Orthop Relat Res. 2012;470(2):610-5. doi: 10.1007/s11999- 011-1990-z
  9. Rippon MG, Rogers AA, Ousey K. Polyhexamethylene biguanide and its antimicrobial role in wound healing: a narrative review. J Wound Care. 2023;32(1):5-20. doi: 10.12968/jowc.2023.32.1.5
  10. Zhou Z, Wei D, Lu Y. Polyhexamethylene guanidine hydrochloride shows bactericidal advantages over chlorhexidine digluconate against ESKAPE bacteria. Biotechnol Appl Biochem. 2015;62(2):268-74. doi: 10.1002/ bab.1255
  11. Papa V, van der Meulen I, Rottey S, Sallet G, Overweel J, Asero N, et al. Safety and tolerability of topical polyhexamethylene biguanide: a randomised clinical trial in healthy adult volunteers. Br J Ophthalmol. 2022;106(2):190-6. doi: 10.1136/bjophthalmol-2020-317848
  12. Findlay A, Serrano C, Punzalan S, Fan SL. Increased peritoneal dialysis exit site infections using topical antiseptic polyhexamethylene biguanide compared to mupirocin: results of a safety interim analysis of an open-label prospective randomized study. Antimicrob Agents Chemother. 2013;57(5):2026-8. doi: 10.1128/aac.02079-12
  13. Castiello G, Caravella G, Ghizzardi G, Conte G, Magon A, Fiorini T, et al. Efficacy of polyhexamethylene biguanide in reducing post-operative infections: a systematic review and meta-analysis. Surg Infect (Larchmt). 2023;24(8):692-702. doi: 10.1089/sur.2023.199
  14. Krikava I, Kolar M, Garajova B, Balik T, Sevcikova A, Pachl J, et al. Polyhexanide anti-infective coating of central venous catheters in prevention of catheter colonization and bloodstream infection: study HC-G-H-0507. Crit Care. 2011;15(1):P229. doi: 10.1186/cc9649

15. Salisbury AM, Mullin M, Chen R, Percival SL. Antibiofilm efficacy of polihexanide, octenidine and sodium hypochlorite/ hypochlorous acid based wound irrigation solutions against Staphylococcus aureus, Pseudomonas aeruginosa and a multispecies biofilm. Adv Exp Med Biol. 2022;1369:53-67. doi: 10.1007/5584_2021_645

  1. Szkołuda P, Karpiński TM. Polyhexanide (PHMB)–properties and applications in medicine. Eur J Biol Res. 2020;10(3):225- 31. doi: 10.5281/zenodo.3956819
  2. Ghosh P, Poopalalingam S, Vallejo A. EP234 Cost-effectiveness, budget impact & healthcare resource savings of topical antimicrobial polyhexamethylene biguanide with a surfactant betaine on wound bed preparation in venous leg ulcers: an analysis in Australia. Journal of Wound Management. 2023;24(2):157.
  3. Rippon M, Rogers AA, Westgate S, Ousey K. Effectiveness of a polyhexamethylene biguanide-containing wound cleansing solution using experimental biofilm models. J Wound Care. 2023;32(6):359-67. doi: 10.12968/jowc.2023.32.6.359
  4. Arıcan M, Çuhadar F, Zamirbekova N. Investigation of the clinical effectiveness of polyhexanid/polyhexamethylene biguanide wound dressing in chronic cases. Harran Univ Vet Fak Derg. 2020;9(2):194-9. doi: 10.31196/huvfd.817720
  5. Assadian O, Kammerlander G, Geyrhofer C, Luch G, Doppler S, Tuchmann F, et al. Use of wet-to-moist cleansing with different irrigation solutions to reduce bacterial bioburden in chronic wounds. J Wound Care. 2018;27(Suppl 10):S10-6. doi: 10.12968/jowc.2018.27.Sup10.S10
  6. Lavery LA, Davis KE, La Fontaine J, Farrar JD, Bhavan K, Oz OK, et al. Does negative pressure wound therapy with irrigation improve clinical outcomes? A randomized clinical trial in patients with diabetic foot infections. Am J Surg. 2020;220(4):1076-82. doi: 10.1016/j.amjsurg.2020.02.044
  7. Strobel RM, Leonhardt M, Krochmann A, Neumann K, Speichinger F, Hartmann L, et al. Reduction of postoperative wound infections by antiseptica (RECIPE)?: A randomized controlled trial. Ann Surg. 2020;272(1):55-64. doi: 10.1097/ sla.0000000000003645
  8. Roth B, Neuenschwander R, Brill F, Wurmitzer F, Wegner C, Assadian O, et al. Effect of antiseptic irrigation on infection rates of traumatic soft tissue wounds: a longitudinal cohort study. J Wound Care. 2017;26(3):79-87. doi: 10.12968/ jowc.2017.26.3.79
  9. Koullias GJ. Efficacy of the application of a purified native collagen with embedded antimicrobial barrier followed by a placental allograft on a diverse group of nonhealing wounds of various etiologies. Wounds. 2021;33(1):20-7. doi: 10.25270/ wnds/2021.2027
  10. Schwarzer S, James GA, Goeres D, Bjarnsholt T, Vickery K, Percival SL, et al. The efficacy of topical agents used in wounds for managing chronic biofilm infections: a systematic review. J Infect. 2020;80(3):261-70. doi: 10.1016/j.jinf.2019.12.017
  11. Wild T, Bruckner M, Payrich M, Schwarz C, Eberlein T, Andriessen A. Eradication of methicillin-resistant Staphylococcus aureus in pressure ulcers comparing a polyhexanide-containing cellulose dressing with polyhexanide swabs in a prospective randomized study. Adv Skin Wound Care. 2012;25(1):17-22. doi: 10.1097/01. ASW.0000410686.14363.ea