Comparison of alcoholic chlorhexidine and povidone-iodine cutaneous antiseptics for the prevention of central venous catheter-related infection: a cohort and quasi-experimental multicenter study.
OBJECTIVE
Compare the effectiveness of different cutaneous antiseptics in reducing risk of catheter-related infection in intensive care unit (ICU) patients.


METHODS
We compared the risk of central venous catheter-related infection according to four-step (scrub, rinse, dry, and disinfect) alcoholic 5 % povidone-iodine (PVI-a, n = 1521), one-step (disinfect) alcoholic 2 % chlorhexidine (2 % CHX-a, n = 1116), four-step alcoholic <1 % chlorhexidine (<1 % CHX-a, n = 357), and four-step aqueous 10 % povidone-iodine (PVI, n = 368) antiseptics used for cutaneous disinfection and catheter care during the 3SITES multicenter randomized controlled trial. Within this cohort, we performed a quasi-experimental study (i.e., before-after) involving the four ICUs which switched from PVI-a to 2 % CHX-a. We used propensity score matching (PSM, n = 776) and inverse probability weighting treatment (IPWT, n = 1592). The end point was the incidence of catheter-related infection (CRI) defined as catheter-related bloodstream infection (CRBSI) or a positive catheter tip culture plus clinical sepsis on catheter removal.


RESULTS
In the cohort analysis and compared with PVI-a, the incidence of CRI was lower with 2 % CHX-a [adjusted hazard ratio (aHR), 0.51; 95 % confidence interval (CI) (0.28-0.96), p = 0.037] and similar with <1 % CHX-a [aHR, 0.73; (0.36-1.48), p = 0.37] and PVI [aHR, 1.50; 95 % CI (0.85-2.64), p = 0.16] after controlling for potential confounders. In the quasi-experimental study and compared with PVI-a, the incidence of catheter-related infection was again lower with 2 % CHX-a after PSM [HR, 0.35; 95 % CI (0.15, 0.84), p = 0.02] and in the IPWT analysis [HR, 0.31; 95 % CI (0.14, 0.70), p = 0.005]. The incidence of CRBSI or adverse event was not significantly different between antiseptics in all analyses.


CONCLUSIONS
In comparison with PVI-a, the use of 2 % CHX-a for cutaneous disinfection of the central venous catheter insertion site and maintenance catheter care was associated with a reduced risk of catheter infection, while the benefit of <1 % CHX-a was uncertain.


BACKGROUND
NCT01479153.
Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France.
Justine
J
Pages
Department of Intensive Care Medicine, General Hospital, Saint Lô, France.
Pascal
P
Hazera
Department of Medial and Toxicologic Intensive Care, Lariboisière University Hospital, Paris, France.
Bruno
B
Mégarbane
Department of Intensive Care Medicine, Caen University Hospital, Caen, France.|EA4655 Risque Microbiens, Caen Normandie Université, Caen, France.
Damien
D
du Cheyron
Department of Intensive Care Medicine, General Hospital, Pontoise, France.
Marie
M
Thuong
Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France.
Jean-Jacques
JJ
Dutheil
Department of Intensive Care Medicine, Caen University Hospital, Caen, France.
Xavier
X
Valette
Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France.
François
F
Fournel
Warren Alpert Medical School of Brown University, Providence, RI, USA.
Leonard A
LA
Mermel
Department of Medial Intensive Care, Cochin University Hospital, Paris, France.
Jean-Paul
JP
Mira
Department of Intensive Care Medicine, Caen University Hospital, Caen, France.
Cédric
C
Daubin
Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France. parienti-jj@chu-caen.fr.|EA4655 Risque Microbiens, Caen Normandie Université, Caen, France. parienti-jj@chu-caen.fr.|Department of Infectious Diseases, Caen University Hospital, Caen, France. parienti-jj@chu-caen.fr.
Jean-Jacques
JJ
Parienti
D000279:Administration, Cutaneous; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D055499:Catheter-Related Infections / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D062905:Central Venous Catheters / Q000009:adverse effects*; D002710:Chlorhexidine / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011206:Povidone-Iodine / Q000008:administration & dosage*; D012306:Risk
D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; D002710:Chlorhexidine
Central venous catheter; Chlorhexidine; Cutaneous disinfection; Nosocomial infection; Povidone–iodine