title: Defatting catheter insertion sites in total parenteral nutrition is of no value as an infection control measure. Controlled clinical trial.
abstract: Defatting the skin with acetone or ether is widely used in the regimen for disinfection of insertion sites of central venous catheters in total parenteral nutrition. The fatty acids secreted by normal skin play an important role in regulation of the cutaneous microbial ecosystem, and it can be questioned whether application of a solvent might paradoxically promote colonization by pathogenic microorganisms. The clinical value of defatting catheter insertion sites was prospectively studied in a controlled, randomized trial: 100 subclavian catheters inserted for total parenteral nutrition were given identical site care except that with one half of the catheters, the site was defatted with acetone prior to catheter insertion and as part of the every-other-day site care regimen. Cutaneous colonization was found in only 130 (24.5 percent) of 531 site cultures in both groups, but was strongly predictive of concordant colonization of the catheter (relative risk, 22.1, p less than 0.001) and catheter-related septicemia (all four cases). No significant differences were observed between the two groups in cutaneous colonization of sites (22.7 percent and 27.0 percent), in colonization of catheters on removal (four catheters [8 percent] in each group) or in catheter-related septicemia (two catheters [4 percent] in each group). However, pain or inflammation of the insertion site was twice as frequent in the acetone group (80 percent versus 35 percent, p less than 0.001). Defatting with acetone as part of the regimen for cutaneous disinfection does not improve microbial removal or reduce the incidence of catheter-related infection, but increases cutaneous inflammation and patient discomfort.
mesh_terms: D000096:Acetone / Q000008:administration & dosage*; D000328:Adult; D001424:Bacterial Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D004203:Disinfection / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D011897:Random Allocation; D012307:Risk Factors; D018805:Sepsis / Q000517:prevention & control; D012867:Skin / Q000187:drug effects* / Q000382:microbiology; D013242:Sterilization / Q000379:methods*
chemical_list: D000096:Acetone