Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care.
BACKGROUND
Although chlorhexidine-based solutions and alcohol-based povidone-iodine have been shown to be more efficient than aqueous povidone-iodine for skin disinfection at catheter insertion sites, their abilities to reduce catheter-related infection have never been compared.


METHODS
Consecutively scheduled central venous catheters inserted into jugular or subclavian veins were randomly assigned to be disinfected with 5% povidone-iodine in 70% ethanol or with a combination of 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzylic alcohol. Solutions were used for skin disinfection before catheter insertion (2 consecutive 30-second applications separated by a period sufficiently long to allow for dryness) and then as single applications during subsequent dressing changes (every 72 hours, or earlier if soiled or wet).


RESULTS
Of 538 catheters randomized, 481 (89.4%) produced evaluable culture results. Compared with povidone-iodine, the chlorhexidine-based solution was associated with a 50% decrease in the incidence of catheter colonization (11.6% vs 22.2% [P = .002]; incidence density, 9.7 vs 18.3 per 1000 catheter-days) and with a trend toward lower rates of catheter-related bloodstream infection (1.7% vs 4.2% [P = .09]; incidence density, 1.4 vs 3.4 per 1000 catheter-days). Independent risk factors for catheter colonization were catheter insertion into the jugular vein (adjusted relative risk, 2.01; 95% confidence interval, 1.24-3.24) and use of povidone-iodine (adjusted relative risk, 1.87; 95% confidence interval, 1.18-2.96).


CONCLUSIONS
Chlorhexidine-based solutions should be considered as a replacement for povidone-iodine (including alcohol-based) formulations in efforts to prevent catheter-related infection.
Mimoz
Olivier
O
Département d'Anesthésie Réanimation, Centre Hospitalier et Universitaire de Poitiers, 86021 Poitiers, France. o.mimoz@chu-poitiers.fr
Villeminey
Stéphanie
S
Ragot
Stéphanie
S
Dahyot-Fizelier
Claire
C
Laksiri
Leila
L
Petitpas
Franck
F
Debaene
Bertrand
B
D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D002405:Catheterization, Central Venous; D016009:Chi-Square Distribution; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000494:pharmacology; D003428:Cross Infection / Q000517:prevention & control*; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000494:pharmacology*; D012307:Risk Factors; D013350:Subclavian Vein
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D002710:Chlorhexidine