A fall in bloodstream infections followed a change to 2% chlorhexidine in 70% isopropanol for catheter connection antisepsis: a pediatric single center before/after study on a hemopoietic stem cell transplant ward.
BACKGROUND
Some catheter-related bloodstream infections originate from catheter connectors; therefore, improved antisepsis of these might be expected to reduce the incidence of such infections.


METHODS
In this observational before/after study at a pediatric tertiary referral hospital, inpatients up to 16 years old undergoing hemopoietic stem cell transplants were studied. Catheter connection antisepsis was changed from 70% isopropanol alone to 2% chlorhexidine in 70% isopropanol. Numbers of catheter-related bloodstream infections before and after the change were monitored as were the numbers of catheter days experienced by patients.


RESULTS
The infection rate before the change was 12 per 1000 catheter-days, and, following the change, this fell to 3 per 1000 catheter-days (P=.004). Similar falls followed the introduction of chlorhexidine to other wards.


CONCLUSIONS
The introduction of chlorhexidine was followed by a profound, sustained fall in catheter-related infections. The results support the 2007 United Kingdom guidelines recommending 2% chlorhexidine in 70% isopropanol as a disinfectant of needleless connectors and hubs of central venous catheters.
Soothill
James S
JS
Department of Microbiology, Level 4 CB Labs, Great Ormond Street Hospital For Children NHS Trust, London, UK. soothj@gosh.nhs.uk
Bravery
Karen
K
Ho
Anne
A
Macqueen
Susan
S
Collins
Jane
J
Lock
Paul
P
D019840:2-Propanol / Q000494:pharmacology; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D000985:Antisepsis / Q000379:methods*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology; D002675:Child, Preschool; D002710:Chlorhexidine / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D004338:Drug Combinations; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D019172:Transplantation Conditioning
D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D019840:2-Propanol; D002710:Chlorhexidine