Prospective Randomized Trial of 10% Povidone‐Iodine versus 0.5% Tincture of Chlorhexidine as Cutaneous Antisepsis for Prevention of Central Venous Catheter Infection

Abstract

A multicenter prospective, randomized, controlled trial, with 0.5% tincture of chlorhexidene versus 10% povidone-iodine as cutaneous antisepsis for central venous catheter (CVC) insertion, was conducted for patients in intensive care units. Of 374 patients, 242 had a CVC inserted for >3 days and were used for the primary analysis. Outcomes included catheter-related bacteremia, significant catheter colonization (> or = 15 colony-forming units [cfu]), exit-site infection, serial quantitative exit-site culture (every 72 h), and molecular subtyping of all isolates. Patients in both study groups were comparable with respect to age, sex, underlying disease, length of hospitalization, reason for line insertion, and baseline APACHE II score. Documented catheter-related bacteremia rates were 4.6 cases per 1000 catheter-days in the chlorhexidine group (n=125) and 4.1 cases per 1000 catheter-days in the povidone-iodine group (n=117; not significant [NS]). Significant catheter-tip colonization occurred in 24 (27%) of 88 patients in the povidone-iodine group and in 31 (34%) of 92 patients in the chlorhexidine group (NS). A mean exit-site colony count of 5.9 x 10(5) cfu/mL per 25 cm(2) of the surface area of skin in the povidone-iodine group versus 3.1 x 10(5) cfu/mL per 25 cm(2) in the chlorhexidine group (NS) was found. There was a trend toward fewer exit-site infections in the chlorhexidine group (0 of 125 patients) versus those in the povidone-iodine group (4 of 117 patients; P=.053). Results of an intention-to-treat analysis were unchanged from the primary analysis. No difference was demonstrable between 0.5% tincture of chlorhexidine and 10% povidone-iodine when used for cutaneous antisepsis for CVC insertion in patients in the intensive care unit.

Guidelines for the prevention of intravascular catheter-related infections

“…Other preparations of chlorhexidine might not be as effective. Tincture of chlorhexidine gluconate 0.5% is no more effective in preventing CRBSI or CVC colonization than 10% povidone iodine, as demonstrated by a prospective, randomized study of adults [74]. However, in a study involving neonates, 0.5% chlorhexidine reduced peripheral IV colonization compared with povidone iodine (20/418 versus 38/408 catheters;…”

Comparative In Vitro Efficacies and Antimicrobial Durabilities of Novel Antimicrobial Central Venous Catheters

“…These measures include, among others, good hand hygiene, the use of maximal sterile barrier precautions during CVC insertion, the use of effective skin antiseptic agents, such as 2% chlorhexidine (CHX), and the use of antimicrobial CVCs, such as those coated with CHX and silver sulfadiazine (CHX/SS) or minocycline and rifampin (M/R) (6,11,13,16,20,27,35). Antimicrobial CVCs represent novel technologic innovations in that the catheter surfaces are coated with antimicrobial agents, rendering them more resistant to colonization by microorganisms.…”

Comparison of two different antiseptics on contamination of epidural catheter tip

“…[12] Antiseptik solüsyonların ve bunlara alkol eklenmesinin etkinliği farklı çalışmalarda test edilmesine rağmen, bu ürünlerin karşılaştırıldığı ça-lışma sayısı azdır. [18,19] İzdeş ve ark. [20] alkol bazlı %2 2-fenoksietanol-%0.1 oktenidin ile %10 povidon iyotun epidural kateter kontaminasyonunu önlemedeki etkinliklerini karşılaştırmışlardır.…”