Do any topical creams improve care of a sterile catheter access site?

Topical Creams for Sterile Catheter Access Sites

Do not use topical antibiotic ointments or creams on catheter insertion sites, as they promote fungal infections and antimicrobial resistance. 1

The Evidence Against Topical Antimicrobials

The Infectious Diseases Society of America provides a Category IB recommendation (strong evidence) explicitly stating that topical antibiotic ointments or creams should not be applied to catheter insertion sites, with the sole exception of dialysis catheters. 1 This recommendation is based on two critical concerns:

• Fungal infection risk: Topical antimicrobials create an environment that promotes fungal overgrowth at the insertion site 1
• Antimicrobial resistance: Routine use contributes to the development of resistant organisms 1
• Catheter material damage: These products may damage the surface of the catheter itself 1

The ESPEN guidelines for central venous catheters echo this recommendation, confirming that antimicrobial ointments are not effective for prevention of catheter site infections. 1

What Actually Works: Chlorhexidine-Based Products

Instead of creams or ointments, the evidence strongly supports chlorhexidine-impregnated sponge dressings as the only topical antimicrobial intervention with proven benefit:

• Use chlorhexidine-impregnated sponge dressings (such as Biopatch) for temporary short-term catheters in patients older than 2 months if infection rates remain elevated despite standard prevention measures 1
• This is a Category IB recommendation, indicating strong evidence for efficacy in reducing extraluminal contamination 1
• Multiple prospective trials demonstrate effectiveness in preventing catheter colonization at the exit site 1

Important caveat: Chlorhexidine-impregnated dressings are not recommended for infants younger than 2 months due to concerns about systemic absorption and skin toxicity 1

Proper Skin Antisepsis Protocol

The correct approach focuses on antiseptic solutions, not creams:

• Prepare skin with 0.5-2% chlorhexidine in alcohol before catheter insertion and during dressing changes 1
• If chlorhexidine is contraindicated, use tincture of iodine, iodophor, or 70% alcohol as alternatives 1
• Allow antiseptics to dry completely according to manufacturer recommendations before applying dressings 1
• Use 2% chlorhexidine wash for daily skin cleansing around the catheter area 2

Appropriate Dressing Selection

Rather than creams, focus on proper dressing materials:

• Use either sterile gauze or transparent semi-permeable dressings to cover the catheter site 1
• Choose gauze dressing if the site is bleeding, oozing, or if the patient has profuse perspiration 1
• Replace dressings when they become damp, loosened, or visibly soiled 1
• Change gauze dressings every 2 days and transparent dressings every 7 days for short-term catheters 1

Common Pitfalls to Avoid

• Never apply topical antibiotics "just in case" - this practice increases harm rather than preventing infection 1
• Do not confuse antiseptic solutions (which are appropriate) with antibiotic creams or ointments (which are contraindicated) 1
• The exception for dialysis catheters does not extend to other catheter types 1
• Chlorhexidine-impregnated dressings are different from chlorhexidine solution - the former is acceptable as a specialized dressing product, the latter is used for skin preparation 1