Chlorhexidine Superior to Iodine-based Solutions to Prevent Catheter Infections

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Chlorhexidine Superior to Iodine-based Solutions to Prevent Catheter Infections

Posted on01 December 2007.

Intravascular catheters are an indispensable part of medical practice. However, catheter-related bloodstream infections (CRBSI) continue to be a major challenge to clinicians. Skin antiseptics, including 2% aqueous chlorhexidine gluconate, 10% povidone-iodine, and 70% alcohol, are important measures that reduce the incidence of CRBSIs. In a recently published study, Dr.Olivier Mimoz, a Professor of Medicine at the University Hospital of Poitiers, France, and colleagues have suggested that chlorhexidine-based solutions may offer better protection against catheter related infections, and should be considered as a replacement for povidone-iodine formulations (Archives of Internal Medicine, 2007).

The team compared chlorhexidine-based solutions and alcohol-based povidone-iodine for their efficacy in reducing catheter-related infections. Patients scheduled for central venous catheter insertion in either jugular or subclavian veins were randomly assigned to be prepared either with 5% povidone-iodine in 70% ethanol or with a combination of 0.25% chlorhexidine gluconate, 0.025% benzalkonium chloride, and 4% benzylic alcohol. The solutions were applied to the skin before insertion of the catheter twice (30 second applications) with sufficient time between applications for the solutions to dry. Subsequently, they were used as single application prior to dressing changes that were done every 72 hours (or earlier if the dressing was soiled or wet).

It was observed that the chlorhexidine-based solutions had a significantly (50% reduction, P = 0.002) lower incidence of catheter colonization compared to povidone-iodine. The incidence of CRBSI in the chlorhexidine group was 9.7 per 1000 catheter-days in contrast to 18.3 per 1000 catheter-days in the povidone-iodine group. The rates of CRBSI were also lower in the chlorhexidine group (1.7% versus 4.2%). In the study, the authors reported that povidone-iodine (adjusted relative risk, 1.87) and catheter insertion into the jugular vein (adjusted relative risk, 2.01) as independent risk factors for catheter colonization.

In the same issue of the journal (Archives of Internal Medicine, 2007), Bleasdale et al reported that daily cleansing of ICU patients with chlorhexidine-impregnated cloths is a simple, effective strategy to decrease the rate of catheter-associated bloodstream infections (BSIs). The conclusions were based on a 52-week, 2-arm, crossover clinical trial that evaluated 832 patients in the ICU. Similarly, a study from Thailand has shown that 2% chlorhexidine gluconate in 70% alcohol is safe, effective, and effective in CVC site care in the ICUs (American Journal of Infection Control, 2007).

The incidence of bloodstream infections associated with central venous catheters is considerably higher than infections with peripheral venous catheters, especially among critically ill patients in the intensive care units (ICU). The average rate of CVC-associated BSIs is estimated to be 5.3 per 1,000 catheter-days in the ICU. In the US, a total of over 250,000 cases of CVC-associated BSIs are estimated to occur annually.

Previous studies evaluating antiseptics against CRBSIs have reported that chlorhexidine-based solutions and alcohol-based povidone-iodine were more efficient than aqueous povidone-iodine. However, earlier studies have not compared the efficacy of chlorhexidine and alcohol based povidone-iodine solutions. The French team of researchers have filled this gap and provides evidence indicating the superiority of chlorhexidine in the prevention of CRBSIs.

References

1. Mimoz O, Villeminey S, Ragot S et al. Chlorhexidine-Based Antiseptic Solution vs Alcohol-Based Povidone-Iodine for Central Venous Catheter Care. Arch Intern Med. 2007; 167:2066-2072.

2. Bleasdale SC, Trick WE,Gonzalez IM et al. Effectiveness of Chlorhexidine Bathing to Reduce Catheter-Associated Bloodstream Infections in Medical Intensive Care Unit Patients. Arch Intern Med. 2007;167:2073-2079.

3. Balamongkhon B, Thamlikitkul V. Implementation of chlorhexidine gluconate for central venous catheter site care at Siriraj Hospital, Bangkok, Thailand. Am J Infect Control. 2007 Nov;35(9):585-8.