Prospective randomized trial of 3 antiseptic solutions for prevention of catheter colonization in an intensive care unit for adult patients.
OBJECTIVE
To compare the effectiveness for prevention of central venous and arterial catheter colonization of 3 skin antisepsis with 1 of 3 antiseptic solutions: 10% aqueous povidone iodine (aqueous PI), 2% aqueous chlorhexidine gluconate (aqueous CG), and 0.5% alcoholic chlorhexidine gluconate (alcoholic CG).


METHODS
Prospective, randomized controlled trial.


METHODS
Intensive care unit in a teaching hospital.


METHODS
Patients were randomly assigned to 1 of the 3 skin antisepsis groups. The distal tips of catheters were semiquantitatively cultured when the catheters were no longer necessary or if there was a suspicion of catheter-related infection. Rates of catheter colonization, catheter-related sepsis, and catheter-related bacteremia were compared among the 3 groups.


RESULTS
A total of 631 catheters were included in the study (194 from the aqueous PI group, 211 from the aqueous CG group, and 226 from the alcoholic CG group). The incidence of catheter colonization was significantly lower in the alcoholic CG than in the aqueous PI group (14.2% vs 24.7%; relative risk, 0.5 [95% confidence interval, 0.3-0.8; P < .01]); it was also significantly lower in the aqueous CG group than in the aqueous PI group (16.1% vs 24.7%; relative risk, 0.6 [95% confidence interval, 0.4-0.9; P = .03]). There were no significant differences between the aqueous CG and the alcoholic CG groups. Incidences of catheter-related bacteremia were similar for all 3 groups. The aqueous and alcoholic CG solutions were superior to the aqueous PI solution in preventing catheter colonization due to gram-positive bacteria.


CONCLUSIONS
The aqueous and alcoholic CG solutions for cutaneous antisepsis were similarly effective in preventing colonization of central venous catheters and arterial catheters. Both had significantly lower incidences of colonization than did the aqueous PI solution; this effect seems to be related to the CG solutions' more efficacious prevention of colonization with gram-positive bacteria.
Vallés
J
J
Critical Care Center, Hospital Sabadell, Institut Universitari Parc Taulí, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Sabadell, Spain. jvalles@cspt.es
Fernández
I
I
Alcaraz
D
D
Chacón
E
E
Cazorla
A
A
Canals
M
M
Mariscal
D
D
Fontanals
D
D
Morón
A
A
D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D000985:Antisepsis / Q000379:methods; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000382:microbiology*; D002710:Chlorhexidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000145:classification / Q000302:isolation & purification; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000627:therapeutic use*; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D016896:Treatment Outcome
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D002710:Chlorhexidine