Comparison of the Efficacy of Antiseptics in Catheter Dressings
Condition: 3rd Level Intensive Care Unit
Study type: Interventional

Summary: 
      Intensive care units (ICUs) are care centers where many different technological tools and
      equipment are used to support the highest level of life functions for patients with severe
      physical condition. With the developing treatment and care methods, the use of more tools and
      equipment for invasive or non-invasive procedures has increased, however, complications
      related to the use of devices and the complications caused by them have also increased.
      Intensive care centers are centers where invasive procedures are frequently applied and
      instruments are used frequently, and central venous catheters (CVCs) are widely used,
      especially for patient-related reasons. CVCs have become one of the most important tools of
      intensive care units due to the different areas in which they are used and the benefits they
      provide.
    

Detailed description: 
      1.625 / 5.000 Çeviri sonuçları star_border A CVC is a cannula placed in a venous vein that
      goes directly to the heart. 4 CVCs are used for frequent blood sampling, continuous Total
      Parenteral Nutrition (TPN) administration, blood and blood product transfusions,
      hemodialysis, long-term fluid replacements, drug treatments in cases where vascular access
      cannot be used due to long-term and intensive treatments. It is used for a variety of
      purposes, such as the delivery of inotropes.

      In addition to the benefits they provide, CVCs also have many negative side effects. The most
      common complications are infection, thrombosis and bleeding. central venous
      catheter-associated bloodstream infections (LVMI-CDE); It is seen as an important problem
      related to the use of central venous catheters in health services in ICUs.

      The day the CVC is placed is recorded as day 1. Laboratory-confirmed BSI can be placed on the
      3rd day of the catheter at the earliest, and the day after the catheter removal at the
      latest.9 The most important step in the management of LVMI-BSI is the prevention of
      infection. In order to prevent these unavoidable infections, precautions should be taken and
      antiseptic rules should be followed during the placement, use and maintenance of CVCs. Nurses
      are responsible for catheter care, monitoring and reporting in case of complications.
      Therefore, the specific care given by nurses has an effect on other catheter-related
      complications and increased infection. Catheter dressings can be considered as risk factors
      for bloodstream infection. For this reason, the antiseptics used during the dressing are also
      important.

      Hypochlorous acid (HOCl), another antiseptic, is a highly effective product that is
      frequently used in dressings and wound care in recent years. Hypochlorous acid is also a
      physiological molecule synthesized by neutrophil cells during phagocytosis and plays an
      active role in the destruction of all microorganisms.

      It has been shown in studies that HOCl inactivates various viruses, including coronaviruses,
      in less than 1 minute. 26 It has been stated that the use of HOCl in eyelid inflammation
      reduces the rate of bacteria on the skin surface. Twenty minutes after application of a
      saline hygiene solution containing HOCl at 100 ppm, more than 99% reduction in staphylococcal
      load was reported.27 In a clinical study of intraperitoneal wound care, in a randomized
      controlled study with forty-four patients aged 3-14 years, 20 patients were lavaged with 100
      ml/kg isotonic into the peritoneal cavity and the wound was washed with 200 ml of isotonic,
      and 26 patients were poured 100 ml/kg into the peritoneal cavity. Lavage was done with HOCl
      and the wound was washed with 200 ml of HOCl. It was stated that no side effects were
      observed. HOCl is extremely ecological because its breakdown produces only brine and traces
      of chloride gas. It is economical as its source is only unsterilized tap water and salt.28 In
      a study examining the effect of stabilized hypochlorous acid solution (HOCl) on the killing
      rate, biofilm formation, antimicrobial activity in the biofilm on frequently isolated
      microorganisms and the migration rate of injured fibroblasts and keratinocytes, all
      microorganisms were killed within 0 minutes and the exact killing time was stated to be 12
      seconds. The stabilized HOCl solution had dose-dependent positive effects on fibroblast and
      keratinocyte migration compared to povidone-iodine and medium alone. It was stated that it
      can be used as an ideal wound care agent.

      In a study on diabetic foot wound, povidone iodine was compared with HOCl. The duration of
      antibiotic use decreased in cases where HOCl acid was used compared to povidone iodine. In
      the studies, in soft tissue and bone tissue; It has been shown to reduce inflammation and
      accelerate wound healing. Topically stabilized HOCl provides an optimal wound healing
      environment and when combined with silicone can be ideal for reducing scarring. Used as an
      antiseptic skin preparation, HOCl poses no concerns of ocular or ototoxicity. The fact that
      it is cheaper than other antiseptic solutions for dressings and is effective in many
      bacterial infections without damaging the tissue may cause more frequent use of hypochlorous
      acid. This study is extremely important in terms of providing evidence to the literature.
      Studies have shown that as a result of the correct nursing care and dressings made with the
      correct products, the rate of bloodstream infections, mortality and morbidity, as well as
      hospital costs due to the catheter, are greatly reduced. In this study, it was aimed to
      compare the effectiveness of antiseptics containing chlorhexidine, povidone iodine and
      hypochlorous acid active ingredient in catheter dressings in preventing central
      catheter-related bloodstream infection in intensive care units.
    

Intervention name(s): hypochlorous active substance
Intervention type(s): Other
Intervention description(s): Poviodin iyot
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Patients meeting the inclusion criteria Patients dressed with 1st group Povidone-iodine antiseptic (routinely applied antiseptic in the clinic)
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: central venous catheter; infection