title: Blood culture contamination rates after skin antisepsis with chlorhexidine gluconate versus povidone-iodine in a pediatric emergency department.
abstract: OBJECTIVE
  To determine blood culture contamination rates after skin antisepsis with chlorhexidine, compared with povidone-iodine.
  
  
  METHODS
  Retrospective, quasi-experimental study.
  
  
  METHODS
  Emergency department of a tertiary care children's hospital.
  
  
  METHODS
  Children aged 2-36 months with peripheral blood culture results from February 2004 to June 2008. Control patients were children younger than 2 months with peripheral blood culture results.
  
  
  METHODS
  Blood culture contamination rates were compared using segmented regression analysis of time-series data among 3 patient groups: (1) patients aged 2-36 months during the 26-month preintervention period, in which 10% povidone-iodine was used for skin antisepsis before blood culture; (2) patients aged 2-36 months during the 26-month postintervention period, in which 3% chlorhexidine gluconate was used; and (3) patients younger than 2 months not exposed to the chlorhexidine intervention (ie, the control group).
  
  
  RESULTS
  Results from 11,595 eligible blood cultures were reviewed (4,942 from the preintervention group, 4,274 from the postintervention group, and 2,379 from the control group). For children aged 2-36 months, the blood culture contamination rate decreased from 24.81 to 17.19 contaminated cultures per 1,000 cultures (P < .05) after implementation of chlorhexidine. This decrease of 7.62 contaminated cultures per 1,000 cultures (95% confidence interval, -0.781 to -15.16) represented a 30% relative decrease from the preintervention period and was sustained over the entire postintervention period. No change in contamination rate was observed in the control group (P = .337).
  
  
  CONCLUSIONS
  Skin antisepsis with chlorhexidine significantly reduces the blood culture contamination rate among young children, as compared with povidone-iodine.
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Marlowe
authors.forename: Rakesh D
authors.initials: RD
authors.lastname: Mistry
authors.forename: Susan
authors.initials: S
authors.lastname: Coffin
authors.forename: Kateri H
authors.initials: KH
authors.lastname: Leckerman
authors.forename: Karin L
authors.initials: KL
authors.lastname: McGowan
authors.forename: Dingwei
authors.initials: D
authors.lastname: Dai
authors.forename: Louis M
authors.initials: LM
authors.lastname: Bell
authors.forename: Theoklis
authors.initials: T
authors.lastname: Zaoutis
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D000985:Antisepsis / Q000379:methods*; D001769:Blood / Q000382:microbiology; D001800:Blood Specimen Collection / Q000379:methods* / Q000592:standards; D002675:Child, Preschool; D002710:Chlorhexidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003470:Culture Media; D004636:Emergency Service, Hospital; D004866:Equipment Contamination; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification; D006095:Gram-Positive Cocci / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D011206:Povidone-Iodine / Q000008:administration & dosage*; D012867:Skin / Q000187:drug effects / Q000382:microbiology
chemical_list: D000891:Anti-Infective Agents, Local; D003470:Culture Media; D011206:Povidone-Iodine; C010882:chlorhexidine gluconate; D002710:Chlorhexidine