title: Alcoholic povidone-iodine or chlorhexidine-based antiseptic for the prevention of central venous catheter-related infections: in-use comparison.
abstract: OBJECTIVE
  To make a field comparison of the effectiveness, ease of use, and cost of a chlorhexidine antiseptic solution (CBA) and an alcohol-based povidone-iodine solution (PVP-IA) for the prevention of central venous catheter (CVC)-related infections in an intensive care unit, with the aim of identifying the superior antisepsis agent.
  
  
  METHODS
  We measured the CVC colonization and infection incidence for PVP-IA (Betadine alcoolique(®)) and for CBA (Biseptine(®)) during two successive 1-year periods of routine surveillance (REA RAISIN network). A questionnaire on the ease of CBA use was administered. Consumption data were obtained from the hospital pharmacy.
  
  
  RESULTS
  The study included 806 CVC (CBA period: 371). Upon switching from PVP-IA to CBA, we recorded a significant reduction in colonization incidence/100 catheter days (1.12 vs. 1.55, p=0.041), nonsignificant differences concerning CVC-related infection incidence/100 catheter days (0.28 vs. 0.26, p=0.426), and a nonsignificant reduction in CVC-related bacteremia/100 catheter days (0.14 vs. 0.30, p=0.052). PVP-IA users were at significantly higher risk of CVC colonization or infection based on a multivariate Cox model analysis (relative risk [95% CI]: 1.48 [1.01-2.15], p=0.043). The main drawbacks of CBA use were its low cleansing activity and its colorless solution. No cost advantage was found.
  
  
  CONCLUSIONS
  Our field study revealed no major clinical advantage of CBA use in CVC infection and no cost advantage in addition to limited ease of use.
authors.affiliation: Hygiene and Epidemiology Unit, CH Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France. raphaele.girard@chu-lyon.fr
authors.forename: Raphaële
authors.initials: R
authors.lastname: Girard
authors.forename: Christine
authors.initials: C
authors.lastname: Comby
authors.forename: Didier
authors.initials: D
authors.lastname: Jacques
mesh_terms: D000891:Anti-Infective Agents, Local / Q000191:economics / Q000627:therapeutic use*; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002710:Chlorhexidine / Q000191:economics / Q000627:therapeutic use*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000517:prevention & control*; D016527:Drug Costs; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D011206:Povidone-Iodine / Q000191:economics / Q000627:therapeutic use*; D000091402:Prohibitins; D016016:Proportional Hazards Models; D011446:Prospective Studies
chemical_list: D000891:Anti-Infective Agents, Local; C000717331:PHB2 protein, human; D000091402:Prohibitins; D011206:Povidone-Iodine; D002710:Chlorhexidine