Chlorhexidine Compared with Povidone-Iodine Solution for Vascular Catheter–Site Care: A Meta-Analysis
Publication: Annals of Internal Medicine
Volume 136, Number 11
Submit a Comment
Contributors must reveal any conflict of interest. Comments are moderated. Please see our information for authorsregarding comments on an Annals publication.
Abstract
Purpose:
Bloodstream infections related to use of catheters, particularly central-line catheters, are an important cause of patient morbidity, mortality, and increased health care costs. This study evaluated the efficacy of skin disinfection with chlorhexidine gluconate compared with povidone-iodine solution in preventing catheter-related bloodstream infection.
Data Sources:
Multiple computerized databases (1966 to 2001), reference lists of identified articles, and queries of principal investigators and antiseptic manufacturers.
Study Selection:
Randomized, controlled trials comparing chlorhexidine gluconate with povidone-iodine solutions for catheter-site care.
Data Extraction:
Using a standardized form, two reviewers abstracted data on study design, patient population, intervention, and incidence of catheter-related bloodstream infection from all included studies.
Data Synthesis:
Eight studies involving a total of 4143 catheters met the inclusion criteria. All studies were conducted in a hospital setting, and various catheter types were used. The summary risk ratio for catheter-related bloodstream infection was 0.49 (95% CI, 0.28 to 0.88) in patients whose catheter sites were disinfected with chlorhexidine gluconate instead of povidone-iodine. Among patients with a central vascular catheter, chlorhexidine gluconate reduced the risk for catheter-related bloodstream infection by 49% (risk ratio, 0.51 [CI, 0.27 to 0.97]).
Conclusions:
These results suggest that incidence of bloodstream infections is significantly reduced in patients with central vascular lines who receive chlorhexidine gluconate versus povidone-iodine for insertion-site skin disinfection. Use of chlorhexidine gluconate is a simple and effective means of reducing vascular catheter–related infections.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Raad I. Intravascular-catheter-related infections. Lancet. 1998;351:893-8. [PMID: 9525387]
2.
Smith RL, Meixler SM, Simberkoff MS. Excess mortality in critically ill patients with nosocomial bloodstream infections. Chest. 1991;100:164-7. [PMID: 2060337]
3.
Martin MA, Pfaller MA, Wenzel RP. Coagulase-negative staphylococcal bacteremia. Mortality and hospital stay. Ann Intern Med. 1989;110:9-16. [PMID: 2908834]
4.
Haley RW, Schaberg DR, Von Allmen SD, McGowan JE Jr. Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods. J Infect Dis. 1980;141:248-57. [PMID: 6767793]
5.
Pittet D, Tarara D, Wenzel RP. Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1994;271:1598-601. [PMID: 8182812]
6.
Arnow PM, Quimosing EM, Beach M. Consequences of intravascular catheter sepsis. Clin Infect Dis. 1993;16:778-84. [PMID: 8329510]
7.
Maki DG, Ringer M, Alvarado CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet. 1991;338:339-43. [PMID: 1677698]
8.
Clemence MA, Walker D, Farr BM. Central venous catheter practices: results of a survey. Am J Infect Control. 1995;23:5-12. [PMID: 7762875]
9.
Sheehan G, Leicht K, O'Brien M, Taylor G, Rennie R. Chlorhexidine versus povidone-iodine as cutaneous antisepsis for prevention of vascular-catheter infection [Abstract]. in: Program and Abstracts—Interscience Conference on Antimicrobial Agents and Chemotherapy. Washington, DC: American Soc for Microbiology; 1993:414(a1616).
10.
Meffre C, Girard R, Hajjar J, Fabry J. Is peripheral venous catheter colonisation related to the antiseptic used for disinfection of the insertion site? Povidone-iodine vs. alcoholic chlorhexidine: a multicenter randomised prospective study [Abstract]. Catheter Study Group. Hygienes. 1995;9:45.
11.
Mimoz O, Pieroni L, Lawrence C, Edouard A, Costa Y, Samii K, et al . Prospective, randomized trial of two antiseptic solutions for prevention of central venous or arterial catheter colonization and infection in intensive care unit patients. Crit Care Med. 1996;24:1818-23. [PMID: 8917031]
12.
Legras A, Cattier B, Dequin PF, Boulain T, Perrotin D. Etude prospective randomisee pour la prevention des infections liees aux catheters: chlorhexidine alcoolique contre polyvidone iodee. Reanimation et Urgences. 1997;6:5-11.
13.
LeBlanc A, Cobett S. IV site infection: a prospective, randomized clinical trial comparing the efficacy of three methods of skin antisepsis. Canadian Intravenous Nurses Association Journal. 1999;15:48-50.
14.
Humar A, Ostromecki A, Direnfeld J, Marshall JC, Lazar N, Houston PC, et al . Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection. Clin Infect Dis. 2000;31:1001-7. [PMID: 11049783]
15.
Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M. Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med. 1987;147:873-7. [PMID: 3555377]
16.
Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977;296:1305-9. [PMID: 323710]
17.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177-88. [PMID: 3802833]
18.
Petitti DB. Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis. 2nd ed. New York: Oxford Univ Pr; 2000.
19.
Light RJ, Pillemer DB. Summing Up: The Science of Reviewing Research. Cambridge, MA: Harvard Univ Pr; 1984.
20.
Donner A, Klar N. Design and Analysis of Cluster Randomization Trials in Health Research. London: Arnold; 2000.
21.
Mallaret MR, Duc DL, Manquat G, Berthieux M. Chlorhexidine or povidone iodine for intravascular catheter maintenance: a bibliographical review. Medecine et Maladies Infectieuses. 1997;27:827-32.
22.
Pearson ML. Guideline for prevention of intravascular device-related infections. Part I. Intravascular device-related infections: an overview. The Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1996;24:262-77. [PMID: 8870910]
23.
Saint S, Veenstra DL, Lipsky BA. The clinical and economic consequences of nosocomial central venous catheter-related infection: are antimicrobial catheters useful? Infect Control Hosp Epidemiol. 2000;21:375-80. [PMID: 10879567]
24.
Veenstra DL, Saint S, Sullivan SD. Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. JAMA. 1999;282:554-60. [PMID: 10450717]
25.
Peacock SJ, Bowler IC, Crook DW. Positive predictive value of blood cultures growing coagulase-negative staphylococci [Letter]. Lancet. 1995;346:191-2. [PMID: 7603263]
26.
Gottardi W. Iodine and iodine compounds. In: Block SS, eds. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia: Lea & Febiger; 1991:151-66.
27.
Zamora JL, Price MF, Chuang P, Gentry LO. Inhibition of povidone-iodine's bactericidal activity by common organic substances: an experimental study. Surgery. 1985;98:25-9. [PMID: 4012604]
28.
Lowbury EJ, Lilly HA. The effect of blood on disinfection of surgeons' hands. Br J Surg. 1974;61:19-21. [PMID: 4204415]
29.
Larson E, Bobo L. Effective hand degerming in the presence of blood. J Emerg Med. 1992;10:7-11. [PMID: 1629595]
30.
Denton WG. Chlorhexidine. In: Block SS, eds. Disinfection, Sterilization, and Preservation. 4th ed. Philadelphia: Lea & Febiger; 1991:274-89.
31.
Ayliffe GA. Surgical scrub and skin disinfection. Infect Control. 1984;5:23-7. [PMID: 6358087]
32.
Smylie HG, Logie JR, Smith G. From Phisohex to Hibiscrub. Br Med J. 1973;4:586-9. [PMID: 4586059]
33.
Shelton DM. A comparison of the effects of two antiseptic agents on Staphylococcus epidermidis colony forming units at the peritoneal dialysis catheter exit site. Adv Perit Dial. 1991;7:120-4. [PMID: 1680406]
34.
Okano M, Nomura M, Hata S, Okada N, Sato K, Kitano Y, et al . Anaphylactic symptoms due to chlorhexidine gluconate. Arch Dermatol. 1989;125:50-2. [PMID: 2910207]
35.
Ebo DG, Stevens WJ, Bridts CH, Matthieu L. Contact allergic dermatitis and life-threatening anaphylaxis to chlorhexidine. J Allergy Clin Immunol. 1998;101:128-9. [PMID: 9449513]
36.
Torricelli R, Wüthrich B. Life-threatening anaphylactic shock due to skin application of chlorhexidine [Letter]. Clin Exp Allergy. 1996;26:112. [PMID: 8789551]
37.
Yong D, Parker FC, Foran SM. Severe allergic reactions and intra-urethral chlorhexidine gluconate. Med J Aust. 1995;162:257-8. [PMID: 7891607]
38.
Snellman E, Rantanen T. Severe anaphylaxis after a chlorhexidine bath. J Am Acad Dermatol. 1999;40:771-2. [PMID: 10321611]
39.
Russell AD, Day MJ. Antibacterial activity of chlorhexidine. J Hosp Infect. 1993;25:229-38. [PMID: 7907620]
40.
Darouiche RO, Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A, et al . A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group. N Engl J Med. 1999;340:1-8. [PMID: 9878638]
41.
Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. JAMA. 1999;281:261-7. [PMID: 9918482]
Information & Authors
Information
Published In
Annals of Internal Medicine
Volume 136 • Number 11 • 4 June 2002
Pages: 792 - 801
History
Published online: 4 June 2002
Published in issue: 4 June 2002
Keywords
Copyright
© 2002 American College of Physicians.
Authors
Metrics & Citations
Metrics
Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
Download article citation data for:
Chlorhexidine Compared with Povidone-Iodine Solution for Vascular Catheter–Site Care: A Meta-Analysis. Ann Intern Med.2002;136:792-801. [Epub 4 June 2002]. doi:10.7326/0003-4819-136-11-200206040-00007
Chlorhexidine Compared with Povidone-Iodine Solution for Vascular Catheter–Site Care: A Meta-Analysis. Ann Intern Med.2002;136:792-801. [Epub 4 June 2002]. doi:10.7326/0003-4819-136-11-200206040-00007
View More
Login Options:
Purchase
You will be redirected to acponline.org to sign-in to Annals to complete your purchase.
Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.
Create your Free Account
You will be redirected to acponline.org to create an account that will provide access to Annals.
Comments
0 Comments