[Critical review of the literature concerning the comparative use of two antiseptic solutions before intravascular or epidural catheterization].
OBJECTIVE
To analyze the most pertinent data from the literature concerning the use of an antiseptic solution before the elaboration of invasive procedures such as blood cultures, insertion of peripheral or central intravenous catheters, and arterial or epidural catheters, and to identify, if any, the "ideal" antiseptic or, at least, the most efficient.


METHODS
Review of the literature. Data collected from the Medline database concerning experimental, clinical and basic research studies published between 1966 and 2003 and a manual research of references of relevant papers.


RESULTS
After a brief historic and pharmacological reminder, the results of experimental and clinical studies are presented. Concerning the clinical studies, they concerned almost exclusively iodine products and chlorhexidine. These comparative studies are classified according to the punction site and the antiseptic solution used.


CONCLUSIONS
Even if the in vitro studies favor iodine products, chlorhexidine in alcoholic solution seems more efficient than povidone iodine in aqueous solution in the clinical setting. Several explanations are suggested to understand the in vitro/in vivo discordances. The place of povidone iodine in alcoholic solution, whose performances on the healthy skin are similar to those of alcoholic chlorhexidine, is being in evaluation.
Clévenot
D
D
Département d'anesthésie et de réanimation chirurgicale, centre hospitalo-universitaire La Milétrie, BP 577, 86021 Poitiers, France.
Robert
S
S
Debaene
B
B
Mimoz
O
O
D000438:Alcohols; D000891:Anti-Infective Agents, Local; D001645:Biguanides; D002404:Catheterization / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002406:Catheterization, Peripheral / Q000009:adverse effects; D002710:Chlorhexidine; D002986:Clinical Trials as Topic; D004352:Drug Resistance, Microbial; D004363:Drug Utilization; D004824:Epidural Space; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017613:Iodine Compounds
D000438:Alcohols; D000891:Anti-Infective Agents, Local; D001645:Biguanides; D017613:Iodine Compounds; D002710:Chlorhexidine