title: Isopropyl alcohol compared with isopropyl alcohol plus povidone-iodine as skin preparation for prevention of blood culture contamination.
abstract: Despite a number of studies on the efficacies of antiseptics for the prevention of blood culture contamination, it still remains unclear which antiseptic should be used. Although the combination of povidone-iodine and isopropyl alcohol has been traditionally used in many institutions, the application of povidone-iodine needs extra time, and there is little evidence that this combination could have an additive effect in reducing contamination rates. To elucidate the additive efficacy of povidone-iodine, we compared two antiseptics, 70% isopropyl alcohol only and 70% isopropyl alcohol plus povidone-iodine, in a prospective, nonrandomized, and partially blinded study in a community hospital in Japan between 1 October 2007 and 21 March 2008. All blood samples for culture were drawn by first-year residents who received formal training on collection techniques. Skin antisepsis was performed with 70% isopropyl alcohol plus povidone-iodine on all inpatient wards and with only 70% isopropyl alcohol in the emergency department. For the group of specimens from inpatient wards cultured, 13 (0.46%) of 2,797 cultures were considered contaminated. For the group of specimens from the emergency department cultured, 12 (0.42%) of 2,856 cultures were considered contaminated. There was no significant difference in the contamination rates between the two groups (relative risk, 0.90; 95% confidence interval, 0.41 to 1.98; P = 0.80). In conclusion, the use of a single application of 70% isopropyl alcohol is a sufficient and a more cost- and time-effective method of obtaining blood samples for culture than the use of a combination of isopropyl alcohol and povidone-iodine. The extremely low contamination rates in both groups suggest that the type of antiseptic used may not be as important as the use of proper technique.
authors.affiliation: Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan. kiyoyama-tky@umin.ac.jp
authors.forename: Tomonori
authors.initials: T
authors.lastname: Kiyoyama
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
authors.forename: Soichi
authors.initials: S
authors.lastname: Shiiki
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Hachiman
authors.forename: Teppei
authors.initials: T
authors.lastname: Shimasaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Endo
mesh_terms: D019840:2-Propanol / Q000494:pharmacology*; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D000985:Antisepsis / Q000379:methods*; D001769:Blood / Q000382:microbiology*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000494:pharmacology*; D011446:Prospective Studies; D012867:Skin / Q000382:microbiology*
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; D019840:2-Propanol