Chlorhexidine gluconate–impregnated central-line dressings and necrosis in complicated skin disorder patients

• Published in: Journal of critical care Vol. 29; no. 6; pp. 1130.e1 - 1130.e4
• Main Authors: Wall, Jennifer B., PA-C, Divito, Sherrie J., MD, PhD, Talbot, Simon G., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local - adverse effects; Bandages; Bone marrow; Burn; Catheter-Related Infections - prevention & control; Catheters; Central line–associated blood stream infections (CLABSIs); Chlorhexidine - adverse effects; Chlorhexidine - analogs & derivatives; Chlorhexidine gluconate (CHG) disk; Critical Care; Critical Illness; Dermatitis; Fatal Outcome; Female; Graft vs host disease (GvHD); Humans; Male; Middle Aged; Patients; Skin; Staphylococcus infections; Stevens-Johnson syndrome (SJS); Stevens-Johnson Syndrome - etiology; Toxic epidermal necrolysis (TENS); Transplants & implants; Wound healing; Young Adult; Burn; Central line–associated blood stream infections (CLABSIs); Toxic epidermal necrolysis (TENS); Stevens-Johnson syndrome (SJS); Chlorhexidine gluconate (CHG) disk; Graft vs host disease (GvHD)
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2014.06.001

Abstract Although chlorhexidine gluconate (CHG) disks have been shown to help reduce the incidence of central line–associated blood stream infections, their use can result in local skin necrosis. The effects of CHG disks on patients with complex skin pathology have not been studied. We report 6 cases of dermal necrosis associated with Biopatch (Ethicon Inc, Somerville, NJ) CHG disks in adults with complex skin pathology including those with Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, burns, and anasarca. All patients had a CHG disk placed at a central venous catheter insertion site. Age range was from 21 to 84 years. Discovery of the reaction ranged from 4 to 14 days after disk placement. Resultant skin erosions required 2 to 10 weeks to reepithelialize. Complicated skin disorder patients represent a rare subset of the critically ill who appear prone to CHG disk necrosis. Continuous contact of CHG under occlusive dressings is speculated to predispose Stevens-Johnson syndrome, toxic epidermal necrolysis syndrome, graft-versus-host disease, and burn patients to local chemical injury secondary to loss of the epithelial tissue barrier, decreased cohesion of the epidermal-dermal junction, and increased tissue permeability. In these patients, the risk of placing the CHG disk may present more risk than using alternative antimicrobial dressings.