Which is more effective for central lines, CHG (Chlorhexidine Gluconate) gel patch or CHG bio patch?

CHG Gel Patch is Superior to CHG Bio Patch for Central Lines

Transparent CHG gel dressings are more effective than CHG sponge (bio patch) dressings for central lines, with a 41% reduction in CLABSI rates and significant cost savings.

Evidence Comparison of CHG Dressing Types

The 2025 International Society for Infectious Diseases position paper strongly recommends applying chlorhexidine gluconate (CHG) dressings for central lines in patients over two months of age, based on high-quality evidence 1. This recommendation is supported by a meta-analysis of 20 studies involving 15,590 catheters that showed CHG dressings significantly reduced central line-associated bloodstream infections (CLABSIs) by 29% (pRR, 0.71; 95% CI, 0.58-0.87), regardless of the CHG dressing type 1.

However, when comparing specific CHG dressing types, a 2023 retrospective analysis of 53,149 hospitalized patients with central venous catheters provides the most recent and highest quality comparative evidence:

• Transparent CHG gel dressings were associated with a 41% decrease in CLABSI rates compared to CHG sponge (bio patch) dressings (0.35% vs 0.60%, P = .0008) 2
• CHG gel dressings resulted in 0.4-day shorter hospital length of stay (9.53 vs 9.90 days, P = .0001) 2
• CHG gel dressings provided cost savings of $3,576 per hospital stay ($40,197 vs $43,774, P = .0179) 2
• No significant difference in contact dermatitis rates was found between the two dressing types 2

Implementation Guidelines

Application Protocol

1. Apply CHG dressings for all central lines in patients over two months of age 1
2. For nontunneled central lines:
   • Replace transparent dressings at least every seven days
   • Perform site care using a CHG-based antiseptic during dressing changes
   • Replace immediately if the dressing becomes soiled, loose, or damp 1

Special Considerations

Patient Risk Factors

• Skin conditions: Use caution in patients with complex skin pathology (Stevens-Johnson syndrome, toxic epidermal necrolysis, graft-versus-host disease, burns) as they may be prone to CHG-related skin necrosis 3
• Age: CHG dressings are not recommended for infants under two months due to risk of severe skin reactions 1

Adverse Effects

• Contact dermatitis is a significant adverse event associated with CHG dressings (pRR, 5.16; 95% CI = 2.09-12.70), particularly in neonates and pediatric populations 1
• Skin erosions from CHG reactions may take 2-10 weeks to heal in patients with complex skin disorders 3

Additional CLABSI Prevention Measures

For comprehensive central line infection prevention:

1. Disinfect catheter hubs, needleless connectors, and injection ports before accessing the catheter 1
2. Consider passive disinfection with caps containing disinfectant agents (70% isopropyl alcohol, iodinated alcohol, or CHG) over needleless connectors 1
3. Maintain appropriate nurse-to-patient ratios and restrict float nurses in ICUs 1
4. Use ultrasound guidance for catheter insertion to reduce complications 1
5. Daily CHG bathing for patients with central lines has been shown to reduce CLABSI rates in both ICU and non-ICU settings 4, 5

Conclusion

Based on the most recent and highest quality comparative evidence, transparent CHG gel dressings should be preferred over CHG bio patch (sponge) dressings for central lines due to their superior effectiveness in reducing CLABSI rates, shorter hospital stays, and cost savings, with comparable safety profiles.