33181
document
Chlorhexidine-based antiseptic solution vs alcohol-based povidone-iodine for central venous catheter care . BACKGROUND Although chlorhexidine-based solutions and alcohol-based povidone-iodine have been shown to be more efficient than aqueous povidone-iodine for skin disinfection at catheter insertion sites , their abilities to reduce catheter-related infection have never been compared . METHODS Consecutively scheduled central venous catheters inserted into jugular or subclavian veins were randomly assigned to be disinfected with 5 % povidone-iodine in 70 % ethanol or with a combination of 0.25 % chlorhexidine gluconate , 0.025 % benzalkonium chloride , and 4 % benzylic alcohol . Solutions were used for skin disinfection before catheter insertion ( 2 consecutive 30-second applications separated by a period sufficiently long to allow for dryness ) and then as single applications during subsequent dressing changes ( every 72 hours , or earlier if soiled or wet ) . RESULTS Of 538 catheters randomized , 481 ( 89.4 % ) produced evaluable culture results . Compared with povidone-iodine , the chlorhexidine-based solution was associated with a 50 % decrease in the incidence of catheter colonization ( 11.6 % vs 22.2 % [ P = .002 ] ; incidence density , 9.7 vs 18.3 per 1000 catheter-days ) and with a trend toward lower rates of catheter-related bloodstream infection ( 1.7 % vs 4.2 % [ P = .09 ] ; incidence density , 1.4 vs 3.4 per 1000 catheter-days ) . Independent risk factors for catheter colonization were catheter insertion into the jugular vein ( adjusted relative risk , 2.01 ; 95 % confidence interval , 1.24-3.24 ) and use of povidone-iodine ( adjusted relative risk , 1.87 ; 95 % confidence interval , 1.18-2.96 ) . CONCLUSION Chlorhexidine-based solutions should be considered as a replacement for povidone-iodine ( including alcohol-based ) formulations in efforts to prevent catheter-related infection .
33182
Intervention_Pharmacological
Chlorhexidine-based antiseptic solution
33183
Intervention_Pharmacological
alcohol-based povidone-iodine
33184
Intervention_Pharmacological
chlorhexidine-based solutions
33185
Intervention_Pharmacological
alcohol-based povidone-iodine
33186
Intervention_Pharmacological
5 % povidone-iodine in 70 % ethanol or with a combination of 0.25 % chlorhexidine gluconate , 0.025 % benzalkonium chloride , and 4 % benzylic alcohol .
33187
Intervention_Pharmacological
povidone-iodine
33188
Intervention_Pharmacological
chlorhexidine-based solution
33189
Intervention_Pharmacological
povidone-iodine
33190
Intervention_Pharmacological
Chlorhexidine-based solutions
33191
Intervention_Pharmacological
povidone-iodine ( including alcohol-based ) formulations
33192
Outcome_Physical
catheter-related infection
33193
Outcome_Other
culture results
33194
Outcome_Adverse-effects
incidence of catheter colonization
33195
Outcome_Adverse-effects
incidence density
33196
Outcome_Adverse-effects
catheter-related bloodstream infection
33197
Outcome_Adverse-effects
incidence density
33198
Outcome_Physical
catheter colonization
33199
Outcome_Physical
catheter-related infection
33200
Participant_Condition
catheter insertion sites
33201
Participant_Condition
central venous catheters
33202
Participant_Sample-size
538
33203
Participant_Sample-size
481