Chlorhexidine locking device for central line infection prevention in ICU patients: protocol for an open-label pilot and feasibility randomized controlled trial

Nasim Zamir, Makena Pook, Ellen McDonald, Alison E Fox-Robichaud, Nasim Zamir, Makena Pook, Ellen McDonald, Alison E Fox-Robichaud

Abstract

Background: Critically ill patients in the intensive care unit (ICU) are at risk for central line-associated bloodstream infection (CLABSI) with an incidence up to 6.9 per 1000 catheter days. CLABSI has a significant attributable mortality and increases in-hospital length of stay, readmissions, and costs. Chlorhexidine gluconate (CHG), a broad-spectrum biocide, has been shown to effectively reduce infections including CLABSI; however, few trials have utilized CHG for prevention of central line infections. Our preclinical work has demonstrated a device that diffuses CHG into the intravenous lock solution of central venous catheters and decreases bacterial growth on the catheter lumen. We designed a clinical trial to test the feasibility of using a CHG device in an ICU patient population.

Methods: The proposed pilot trial will be a single centre, open-label, two-arm, parallel group feasibility randomized controlled trial (RCT). Participants will have a central line in situ and will be enrolled within 72 h of admittance to 3 ICUs at a single academic hospital. Exclusion criteria will include suspected infection, chronic indwelling catheters, and CHG allergy. Informed consent will be obtained from eligible participants or their substitute decision maker prior to randomization. Participants will be randomized to receive either usual care or the CHG locking device. Blood cultures will be drawn from all participants every 48 h. The primary objective of this study will be to determine the feasibility of using this protocol to conduct a larger trial. Feasibility will be assessed through the following outcomes: (1) consent rate, (2) recruitment rate, (3) protocol adherence, and (4) comfort level with the device. The secondary objective of this study will be to establish the preliminary efficacy of the device.

Discussion: This study will be the first human RCT to investigate a CHG locking device for the prevention of central line infections. Findings from this trial will inform the feasibility of conducting a large RCT and provide preliminary data on the efficacy of a CHG locking device.

Trial registration: ClinicalTrials.gov, NCT03309137, registered on October 13, 2017.

Keywords: CHG; CLABSI; Central line infection; Central venous catheter; Chlorhexidine; Device; Prevention; Sepsis.

Conflict of interest statement

Competing interestsICU Medical and ATTWILL do not have input into the design or implementation of this study or have access to study data until analysis is complete. ICU Medical was involved in training the bedside nursing staff on appropriate use of ChloraLockTM. AFR did not receive any personal financial compensation for conducting the trial.

© The Author(s). 2020.

Figures

Fig. 1
Fig. 1
The ChloraLockTM device contains freeze-dried CHG (arrow) that dissolves with introduction of the locking solution
Fig. 2
Fig. 2
Flow of participants

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